title: Prevalence of hyperuricemia among Chinese adults: a national cross-sectional survey using multistage, stratified sampling.
abstract: BACKGROUND
  Hyperuricemia is a non-communicable disease that threatens human health, and its prevalence has been increasing in recent decades. However, there have been no national surveys about hyperuricemia performed in China. We aimed to investigate the prevalence of hyperuricemia and its risk factors in Chinese adults.
  
  
  METHODS
  Using data from 36,348 participants aged 18 years and older from the China National Survey of Chronic Kidney Disease (a nationwide cross-sectional survey with a randomized, multistage, stratified sampling strategy), we investigated the prevalence of hyperuricemia. Male subjects with serum uric acid ≥416.0 μmol/l (7.0 mg/dl) and female subjects with ≥357.0 μmol/l (6.0 mg/dl) were diagnosed with hyperuricemia. The prevalence of hyperuricemia was calculated, and the factors associated with hyperuricemia were analyzed using logistic regression.
  
  
  RESULTS
  The adjusted prevalence of hyperuricemia among Chinese adults in 2009-2010 was 8.4 % [95 % confidence interval (CI) 8.0-8.8 %], and it was 9.9 % (9.2-10.6 %) in men and 7.0 % (6.5-7.5 %) in women. The prevalence was much higher among urban than rural residents (14.9 vs. 6.6 %, p < 0.01). Areas with high per capita gross domestic product (GDP) levels had higher prevalence of hyperuricemia. In the multivariate regression model, the estimated glomerular filtration rate was inversely associated with hyperuricemia. Alcohol consumption, body mass index and serum triglyceride levels were positively correlated with hyperuricemia. Other factors independently correlated with hyperuricemia were age, sex, education level, area of residence, and economic development. In order to demonstrate the discriminatory power for hyperuricemia of the risk factors all together, we calculated the probabilities by logistic regression analysis, which represented the combined effects of these risk factors. Then, receiver operating characteristic analysis was used to demonstrate the value of the probabilities for hyperuricemia diagnosis. Finally, ROC curve analysis revealed the area under the curve was 0.746 (95 % CI 0.739-0.754), statistically significant for the association with hyperuricemia of these risk factors considered all together (p < 0.001).
  
  
  CONCLUSIONS
  Hyperuricemia is prevalent in the economically developed areas of China. Our report indicates the feasibility of studying the influence that economic changes have on the prevalence of hyperuricemia.
authors.affiliation: Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, 210009, Jiangsu, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.affiliation: Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, 210009, Jiangsu, China.
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Zhang
authors.affiliation: Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, 210009, Jiangsu, China.
authors.forename: Yan-Li
authors.initials: YL
authors.lastname: Wang
authors.affiliation: Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, 210009, Jiangsu, China. liubc64@163.com.
authors.forename: Bi-Cheng
authors.initials: BC
authors.lastname: Liu
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D012111:Residence Characteristics; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid
keywords: China; Epidemiology; Hyperuricemia; Prevalence