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Gout

The gout domain of the Atlas of Healthcare Variation provides information on gout by demographics, health district and primary health organisation (PHO).

About the data

The information in this domain includes an estimate of those likely to have gout (based on parameters from service use) and how their gout is managed. The data is not intended to form definitive statements of quality, rather to raise questions about potential areas for quality improvement.

Data for 2019–2024; released September 2026

Access the Gout Atlas of Healthcare Variation

What is gout

Gout is the most common form of inflammatory arthritis. It is caused by an inflammatory response to monosodium urate (MSU) crystals, which form in the presence of high urate concentrations. Patients typically present initially with recurrent flares of severe joint inflammation. Over time, the presence of elevated serum urate concentrations (hyperuricaemia) can lead to:

  • tophus formation
  • chronic gouty arthritis
  • progressive joint damage.

Long-term urate-lowering therapy is recommended for patients with recurrent gout flares (two or more per year), tophaceous gout and/or joint damage. Allopurinol is the first-line urate-lowering therapy drug in New Zealand, but when indicated, probenecid and febuxostat are also effective. Target serum urate of < 0.36 mmol/L is needed to dissolve MSU crystals, suppress gout flares and aid tophi regression. Gout flares can be treated with NSAIDs, colchicine or corticosteroids (Lindsay et al 2011; Martini et al 2012; Dalbeth et al 2013), and low-dose colchicine or corticosteroids are also recommended for initial introduction of urate-lowering therapy to prevent flares related to fluxes in serum urate concentration.

We encourage you to use the atlas data to understand disease burden and dispensing patterns in your region to ensure your patients are getting the best possible treatment for their condition.

What the data shows

Data is from 2019 to 2024 and can be viewed by age, gender and ethnic grouping. Variation by health district and PHO are also presented. We use indicators to show data; these indicators were developed with the help of an expert advisory group.

The methodology for some indicators has been updated in this edition of the atlas, including changes to look-back periods and case definitions. As a result, estimates may differ from those reported in previous editions and should not be directly compared. Please see methodology for more information.

For quality improvement purposes, the atlas presents observed (crude) rates. These rates reflect the actual experience of the population and support local service planning and improvement activities. However, when comparing ethnic groups to understand equity, we recommend using age-specific rates.

Selected findings from the atlas are summarised below. For all indicators and detailed commentary, see the atlas dashboards.

Key messages

  • In 2024, 6.3 percent of the PHO‑enrolled population aged 20 years or over were estimated to have gout.

  • Crude estimates for gout were higher for Pacific peoples and Māori than non-Māori non-Pacific peoples. For example, among those aged 20–44 years, crude estimates for Pacific peoples (7.9 percent) and Māori (4.4 percent) were about five times and three times higher respectively than the rate for non-Māori, non-Pacific (1.5 percent).

  • Young Pacific people (56 percent) and Māori (51.5 percent), aged 20–44 years, estimated with gout were more likely than non-Māori, non-Pacific (48.1 percent) to receive urate-lowering therapy at any time during the year. However, they were less likely to receive this therapy regularly (Māori: 20.6 percent; Pacific peoples: 21.5 percent; non-Māori non-Pacific peoples: 24.1 percent).

  • Younger people (20–44 years) with estimated gout, particularly Māori and Pacific peoples, were dispensed non-steroidal anti-inflammatory drugs (NSAIDs) at significantly higher rates than other groups with estimated gout.

  • Overall, 14 percent of people with estimated gout were dispensed NSAIDs at any time during the year but were not dispensed urate-lowering therapy. These rates varied by district, for example, ranging from 13.9 to 23.0 percent among those aged 20–44 years.

  • Overall, crude rates for hospital admission as a result of gout for Māori (1,286 per 100,000) and Pacific peoples (1,487 per 100,000) were nearly 2.5 times the rate for non-Māori, non-Pacific populations (513 per 100,000).

Pacific peoples, Māori, men and people aged 65 years or over were most affected

  • Estimated gout prevalence increases with age, with 13.1 percent of people aged 65 years or over estimated to have gout compared with 2.4 percent among those 20–44 years old.
  • Men were more likely to be estimated to have gout compared with women. For example, among those aged 20–44 years, men (4.3 percent) were about six times more likely than women (0.7 percent) to be estimated to have gout. 
  • Crude estimates for gout were higher for Pacific peoples and Māori than non‑Māori non‑Pacific peoples. For example, among those aged 20–44 years, Pacific peoples (7.9 percent) were about five times and Māori (4.4 percent) were about three times more likely than non-Māori, non-Pacific (1.5 percent) to be estimated to have gout.
  • Rates of estimated gout prevalence varied significantly by district. For example, among those aged 20–44 years, rates varied approximately threefold, from 1.4 to 4.0 percent.
  • Evidence shows that younger men with gout experience barriers to accessing care (Te Karu et al 2020). This means our method may further underestimate prevalence in younger age groups.

Pacific peoples and Māori were less likely to regularly receive urate-lowering therapy than non-Māori, non-Pacific peoples

  • People experience the benefits of urate-lowering therapy when it is used continuously long term. Any dispensing was defined as people dispensed medicine at least once in a year. Regular dispensing was defined as people dispensed medicine in three or four quarters in a year. Regular dispensing indicated medicine persistence, that is, the availability of medicine to a person over the year.
  • Among people aged 20–44 years with estimated gout, Pacific peoples (56 percent) and Māori (51.5 percent) were more likely than non-Māori, non-Pacific (48.1 percent) to receive urate-lowering therapy at any time during the year. However, Māori (20.6 percent) and Pacific peoples (21.5 percent) were less likely than non-Māori, non-Pacific (24.1 percent) to receive it regularly.
  • The same treatment levels for different populations do not necessarily mean equitable treatment. In this case, gout in Māori and Pacific peoples has a different clinical profile from gout in other groups, characterised by earlier onset and more severe disease (Dalbeth et al 2018). This means to achieve equitable care would require higher levels of urate-lowering therapy for Māori and Pacific peoples at a younger age.
  • Dispensing of urate lowering medication increased with age, with about 53.6 percent those aged 65 years or over regularly receiving urate lowering medication compared with 22.5 percent of those aged 20–44 years.
  • Men were more likely to regularly receive urate-lowering therapy compared with women. For instance, men aged 20–44 years (24.1 percent) were about two times more likely than women (12.8 percent) in that age group to regularly receive urate-lowering therapy.
  • Regular dispensing rates varied one-and-a-half-fold by district; for example, among those aged 20–44 years old, rates ranged from 18.5 to 27.5 percent.

NSAIDs were dispensed to 36 percent of those estimated to have gout

  • In 2024, 36.3 percent of the PHO-enrolled population aged 20 years and over who were estimated to have gout were dispensed an NSAID compared with 26.0 percent of the PHO-enrolled population aged 20 years and over without gout.
  • Rates were consistent between 2019 and 2024.
  • Younger people (20 to 44 years) with estimated gout were more likely to be dispensed NSAIDs (51.7 percent) than those aged 45 to 64 years (42.3 percent) or 65 years and over (25.7 percent). Ethnic differences were most pronounced among younger people, with Māori (54.0 percent) and Pacific peoples (59.1 percent) significantly more likely to be dispensed NSAIDs than non-Māori, non-Pacific peoples (46.6 percent).

An NSAID without any urate-lowering therapy was dispensed in 14 percent of people estimated to have gout

  • On average, 13.8 percent of people with gout received an NSAID in a year without any urate-lowering therapy being dispensed. Rates were the same across all ethnic groups.
  • Rates consistently decreased with age, with 19.6 percent of those aged 20–44 years with gout receiving funded NSAID without urate-lowering therapy compared with 10.0 percent of those aged 65 years or over.
  • Rates varied significantly by district, for example, from 13.9 to 23.0 percent among those aged 20–44 years.
  • NSAIDs may be prescribed for conditions other than gout, including musculoskeletal pain, arthritis and injury-related pain. However, because this analysis is restricted to people estimated to have gout, dispensing of NSAIDs without urate-lowering therapy may indicate reliance on treatment of acute symptoms rather than long-term gout management.
  • Evidence shows that Māori and Pacific peoples are more likely to experience renal impairment ((Walker et al 2019; bpacnz 2026). Given that gout prevalence is also higher in these populations, higher rates of NSAID use without urate-lowering therapy may be of concern because NSAIDs can worsen kidney function, particularly among people with existing renal disease. This highlights the importance of effective long-term gout management. This includes appropriate use of urate-lowering therapy to reduce the need for repeated NSAID use and minimise the risk of kidney-related complications.

Māori and Pacific peoples with gout were more likely to receive colchicine, prednisone or NSAIDs in a year with any urate-lowering therapy

  • Among people receiving urate-lowering therapy, some also received medicines used to treat acute gout flares (colchicine, prednisone, or an NSAID). This may indicate ongoing gout flares despite treatment, which could suggest that urate-lowering therapy was not yet optimised or that serum urate targets had not been achieved.
  • Among those aged 20–44 years, Pacific peoples with gout were more likely to receive colchicine, prednisone or an NSAID (70.2 percent), followed by Māori (66.0 percent). This dropped to 57.3 percent for non-Māori, non-Pacific peoples. However, Pacific peoples (21.4 percent) were less likely to receive them without any urate-lowering therapy than Māori (23.6 percent) and non-Māori, non-Pacific peoples (24.1 percent).
  • In 2024, 51.9 percent of those estimated to have gout received either colchicine, prednisone or an NSAID, while 19.2 percent received one of these and did not receive urate-lowering therapy.
  • Young people aged 20–44 years (23.3 percent) were more likely to receive colchicine, prednisone or an NSAID without urate-lowering therapy than people in other age groups (45–64: 20.3 percent; 65 years or over:16.8 percent).
  • Rates varied significantly by district, for example, from 19.4 to 27.3 percent among those aged 20–44 years.

Māori and Pacific peoples estimated to have gout had nearly 2.5 times as many hospital admissions for gout as non-Māori, non-Pacific people

  • Crude rates of hospital admission for gout among people estimated with gout have remained relatively stable since 2019. There is one exception of a notable decrease in 2022 in some districts (possibly related to impacts of COVID-19 on health service delivery). Crude admission rates were nearly 2.5 times higher for Māori (1,286 per 100,000) and Pacific people (1,487 per 100,000) than for non-Māori, non-Pacific populations (513 per 100,000) with gout.
  • Admissions due to gout for people aged 20–44 years (1,249 per 100,000) were almost double those of any other age group.
  • This indicator measures hospital admission events as a result of gout among people estimated to have gout. As individuals can be admitted more than once, the results reflect admissions rather than the number of people admitted.

Of the PHO-enrolled population, admissions for gout were eight times higher for Pacific peoples and five times higher for Māori than for non-Māori, non-Pacific peoples

  • Crude hospital admission rates as a result of gout among the PHO-enrolled population have slightly increased over time (50.8 per 100,000 in 2024 compared with 44.8 per 100,000 in 2019), especially for Pacific peoples.
  • Hospital admissions for gout were 8 times higher for Pacific peoples (213.9 per 100,000), and five times higher for Māori (131.2 per 100,000) than for non-Māori, non-Pacific peoples (26.4 per 100,000).
  • This indicator measures hospital admissions for gout among the total PHO-enrolled population and provides an indication of the impact gout has on hospital admissions, including the burden of severe gout and associated inequities across population groups.

Questions raised

  • Why are Pacific peoples more likely to receive urate‑lowering therapy at least once yet less likely to receive it regularly?
  • How do districts with similar population distributions compare in treatment patterns and outcomes?
  • Why are younger people less likely to receive regular urate‑lowering therapy?
  • Why are NSAIDs used so frequently, particularly among younger Māori and Pacific patients? Are there differences in prescribing practices across districts or providers?
  • Why are Pacific peoples and Māori experiencing higher admission rates for gout, and how much of this is preventable? Are these admissions driven by delayed treatment or limited access to primary health care? Are the admissions a consequence of more severe disease (which should be an indication for more intensive treatment)?
  • What opportunities exist to prevent gout onset in high‑risk groups? How can early identification and management be improved in younger populations? What roles do comorbidities and social determinants play in prevention?

Data sources and methodology

A key change was made to the numerator calculation to more accurately capture people with gout. We have observed an increase in colchicine prescribing for conditions other than gout, such as pericarditis, other crystal arthropathies and periodic fever syndromes. To address this, we excluded individuals dispensed colchicine who had a relevant hospital record (based on the ICD diagnosis codes listed below) within the 2 years before the colchicine dispensing. This resulted in the exclusion of 4,836 people in 2024, representing approximately 2% of the cohort.

Excluded ICD diagnosis codes:

  •  I010 Acute rheumatic pericarditis
  • I092 Chronic rheumatic pericarditis
  • I300 Acute nonspecific idiopathic pericarditis
  • I301 Infective pericarditis
  • I308 Other forms of acute pericarditis
  • I309 Acute pericarditis, unspecified
  • I310 Chronic adhesive pericarditis
  • I311 Chronic constrictive pericarditis
  • I32 Pericarditis in diseases classified elsewhere
  •  I319 Diseases of pericardium, unspecified
  • M11 Other crystal arthropathies
  • E85.0 Non-neuropathic heredofamilial amyloidosis

 Another key change was the application of a 15-year rolling look-back period to identify prevalent gout cases for each reporting year. For example, for the 2024 reporting year, gout status was determined using data from 1 January 2010 to 31 December 2024.

Previously, the look-back period had a fixed start point of 1988 for hospital admissions and 2001 for dispensing gout-specific urate-lowering therapies (allopurinol, febuxostat, benzbromarone) or colchicine. As a result, the look-back period increased each year as the estimates were updated. Because the look-back period increased each year, estimates may have been influenced by the growing amount of historical data available rather than changes in the prevalence of gout. Moving to a fixed look-back period improves comparability between years, provides a more consistent case definition and makes trends over time easier to interpret.

In this update, we excluded a key quality indicator measuring serum urate testing within 6 months of urate‑lowering therapy dispensing (Dalbeth et al 2015) . This was due to incomplete coverage of the laboratory claims dataset in some districts, as well as the increasing use of point‑of‑care serum urate testing, which may not be captured in the laboratory claims collection. We recommend practitioners reflect on / audit where possible their own practice in relation to this indicator.

For each of the indicators in this atlas domain, it was not possible to assess whether:

  • the medicine was clinically indicated
  • the dose was optimal (including the recommended starting and maintenance dose of urate-lowering therapy)
  • anti-inflammatory prophylaxis was prescribed at the time of starting urate-lowering therapy
  • the medicine was taken.

Analyses by ethnicity used prioritised ethnicity, whereby individuals reporting multiple ethnicities were assigned to one ethnic group according to the standard Ministry of Health prioritisation order. This ensured ethnic groups were mutually exclusive and allowed comparisons between groups. We acknowledge that this method may underestimate results for Pacific peoples, as individuals who identify with both Pacific and Māori ethnicities are classified within the Māori group. We also acknowledge that Pacific peoples are not a homogenous population, comprising various communities with distinct languages, cultures and identities. For estimates for the total Pacific population or specific Pacific ethnic groups, please contact us at info@hqsc.govt.nz.

The Asian peoples grouping has been combined with the European/Other groups in the non-Māori, non-Pacific group in this atlas. This is because the overall estimated gout prevalence for Asian populations (3.7 percent) is lower than the European/Other population (5.6 percent), and in some districts, the small size of the Asian population means many results were suppressed. Middle Eastern, Latin American and African (MELAA) peoples has also been included in the European/Other grouping and hence non-Māori, non-Pacific group in this atlas.

The methodology report has more information on the indicators, data sources, definitions and rationale we used to gather this data.

Atlas of Healthcare Variation: Methodology for Gout (PDF 792KB)

Atlas of Healthcare Variation: Methodology for Gout (DOCX 426KB)

As the current update covers data from the 2019–2024 period, historical results can be accessed from Atlas of Healthcare Variation Gout.

Please note the methodology changes above and accompanying methodology document

More information

References

Further reading

Published: 2 Sep 2026 Modified: 7 Sep 2026