Abstract
Multimorbidity, particularly cardiometabolic multimorbidity (CMM), is a growing global health challenge, defined by the co-occurrence of cardiometabolic diseases (CMDs) like type 2 diabetes, ischemic heart disease, and stroke. While serum uric acid (SUA) and gout have been linked to various chronic conditions, their roles in multimorbidity and the CMM trajectory remain unexplored in large populations. Using data from over 400,000 UK Biobank participants, we explored the associations between SUA, gout, 36 chronic conditions, and multimorbidity. A multi-state model was applied to investigate SUA and gout’s roles in the CMM trajectory, including transitions from CMD-free status to first CMD (FCMD), CMM, and death. Analyses were conducted for the overall population and stratified by sex. We observed that higher SUA levels and gout were associated with a higher likelihood of multimorbidity and multiple chronic conditions, particularly CMDs. Multi-state analysis revealed that both SUA and gout increased the risk of most transitions. Classifying FCMDs by specific CMDs further revealed distinct roles of SUA/gout in disease-specific transitions, even at the same stage. Sex-specific analyses showed a stronger impact in females compared to males. These findings highlight the importance of managing SUA levels and gout to prevent multimorbidity and slow CMM progression, particularly in females.
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Acknowledgements
We thank all participants in the UK Biobank cohort for their contribution. We also thank BioRender (biorender.com) for providing items for drawing the figure in the study. This work was supported by the Joint Funds of National Natural Science Foundation of China [grant number U22A20365], National Natural Science Foundation of China [grant number T2341019], Noncommunicable Chronic Diseases-National Science and Technology Major Project [grant number 2025ZD0550800], the Guangzhou Science and Technology Plan Project [grant number 2024B03J1343], the Natural Science Foundation of Guangdong Province, China [grant number 2023A1515110757], Major scientific and technological project of Guangzhou Municipal Health Commission [grant number 2025ZD003], Medical Scientific Research Foundation of Guangdong Province [grant number A2023322], and Science and Technology Program of Dongguan, China [grant number 20231800913372]. The funders had no role in the study design, data collection, analysis, or preparation of the manuscript.
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Wu, C., Zhong, G., Yang, Y. et al. Serum uric acid, gout, cardiometabolic diseases, and multimorbidity: a prospective cohort study using multi-state model. npj Aging (2026). https://doi.org/10.1038/s41514-026-00413-6
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DOI: https://doi.org/10.1038/s41514-026-00413-6
