Men get gout far more often than women, at a ratio somewhere between 3-to-1 and 10-to-1 depending on the population studied. But sex is only one piece of the picture. Age, ethnicity, body weight, kidney function, and even what you drink all play significant roles in determining who develops this painful form of arthritis. Globally, about 55.8 million people had gout in 2020, a number that rose more than 22% since 1990.
Men vs. Women: The Hormone Factor
Gout is overwhelmingly a condition that affects men, particularly from their 30s onward. The reason comes down to estrogen. In premenopausal women, estrogen helps the kidneys flush out uric acid, the substance that crystallizes in joints and causes gout flares. This natural protection keeps gout relatively rare in younger women.
After menopause, that protection fades. Women who had a later start to their periods, earlier menopause, or a shorter total span of reproductive years face a higher risk. A large Korean study of one million postmenopausal women found that shorter lifetime exposure to estrogen was consistently linked to more gout diagnoses. By age 65 and older, the gap between men and women narrows considerably, though men still lead in overall numbers.
Age: Risk Climbs Every Decade
Gout prevalence rises steadily with age. Among people over 80, prevalence reaches 11 to 13%, and roughly 4 in 1,000 people in that age group develop new gout each year. This happens partly because kidney function gradually declines with age, making the body less efficient at clearing uric acid. Decades of dietary exposure, medication use, and accumulating health conditions all compound the effect.
Pacific Islander and Māori Populations
Some of the highest gout rates in the world are found among Pacific Islander (Pasifika) and Māori communities. In New Zealand, 2019 data showed a gout prevalence of 14.8% among Pasifika peoples, 8.5% among Māori, and 4.7% among other New Zealanders who are predominantly of European descent. Among Pasifika men aged 65 and older, nearly half (49.6%) had gout.
These striking numbers reflect a combination of genetic and social factors. Pacific Island populations carry gene variants that make them less efficient at excreting uric acid through the kidneys. But genetics alone don’t explain the full picture. Inequities in healthcare access, higher rates of related conditions like obesity and kidney disease, and dietary shifts toward processed foods all contribute. Pasifika peoples also show elevated gout rates in their home countries, suggesting that genetic predisposition is a strong baseline factor that environment and diet then amplify.
Genetics Beyond Ethnicity
Several specific genes influence how your body handles uric acid, and variants in these genes can raise or lower your risk regardless of your ethnic background. The most well-studied involve proteins that act as uric acid transporters in the kidneys and gut. One common variant, known as Q141K in the ABCG2 gene, reduces the body’s ability to excrete uric acid and significantly increases gout risk. Variants in two other transporter genes, SLC2A9 and SLC22A12, can either protect against gout or raise the odds depending on which version you carry. One protective variant in SLC2A9, for instance, is more than twice as common in the general European population compared to gout patients.
These genetic factors help explain why gout runs in families. If your parents or siblings have gout, your own risk is meaningfully higher, even before diet or weight enter the equation.
Obesity, Kidney Disease, and High Blood Pressure
Gout rarely travels alone. It clusters heavily with metabolic and cardiovascular conditions, and these conditions also make gout more likely in the first place.
Kidney disease is one of the strongest risk amplifiers. Your kidneys are responsible for filtering out most of the uric acid in your blood. When they struggle, uric acid builds up. In a large study of patients with advanced chronic kidney disease, 23% met the criteria for gout, with the rate peaking at 28% in more severe stages. Among those gout patients, 85% also had high blood pressure and 44% were obese. Gout patients with kidney disease also had significantly higher rates of cardiovascular disease and bone disorders compared to kidney disease patients without gout.
Obesity drives gout risk through multiple pathways. More body tissue means more uric acid production, and excess weight is linked to insulin resistance, which reduces the kidneys’ ability to clear uric acid. High blood pressure creates a similar problem by reducing blood flow to the kidneys.
Sugary Drinks and Alcohol
What you drink matters more than most people realize. In a large study of women, drinking one sugar-sweetened soda per day raised gout risk by 74% compared to having less than one per month. Two or more sodas per day more than doubled the risk. The culprit is fructose, which the body breaks down into uric acid as a byproduct of metabolism. Orange juice, which is also high in fructose, carried a similar risk increase.
Alcohol works through a different mechanism. Beer is the worst offender because it contains purines (compounds the body converts to uric acid) in addition to the alcohol itself, which impairs uric acid excretion. In men, two or more beers per day raised gout risk by about 2.5 times. Liquor increased risk as well, though less dramatically, at about 1.6 times for two or more servings daily. Wine appears to carry the lowest risk among alcoholic beverages.
Medications That Raise Risk
Certain medications can tip you into gout territory by raising uric acid levels. Diuretics, commonly prescribed for high blood pressure and heart failure, are the most well-known trigger. They work by increasing urine output, which concentrates uric acid in the blood. An analysis of the FDA’s adverse event database identified over 170 drugs associated with gout, with diuretics and blood pressure medications among the most frequently reported. Some cancer treatments also appeared high on the list, particularly drugs used for blood cancers.
If you take a diuretic and have other gout risk factors, that combination can be enough to push uric acid levels past the crystallization threshold. This is one reason gout often first appears in people already being treated for high blood pressure or heart disease.
Putting the Risk Factors Together
The person most likely to develop gout is a man over 50 with excess weight, high blood pressure, and some degree of kidney impairment, especially if he drinks beer regularly or has a family history of the condition. But gout doesn’t follow a single profile. Postmenopausal women, people taking diuretics, anyone with Pacific Island or Māori ancestry, and people who drink multiple sodas a day are all at elevated risk. Most gout patients have three or more of these risk factors layered together, which is why the condition so often appears alongside a cluster of other health problems rather than in isolation.