Abstract: Articles Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study Ruth K Topless, Angelo Gaffo, Lisa K Stamp, Philip C Robinson, Nicola Dalbeth, Tony R Merriman Summary Lancet Rheumatol 2022; 4: e274–81 Published Online January 28, 2022 https://doi.org/10.1016/ S2665-9913(21)00401-X See Comment page e233 Biochemistry Department, University of Otago, Dunedin, New Zealand (R K Topless BSc, Prof T R Merriman PhD); Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA (A Gaffo MD, Prof T R Merriman); Birmingham Veteran Affairs Medical Center, Birmingham, AL, USA (A Gaffo); University of Otago Christchurch, Christchurch, New Zealand (Prof L K Stamp PhD); University of Queensland, Brisbane, QLD, Australia (P C Robinson PhD); Department of Medicine, University of Auckland, Auckland, New Zealand (Prof N Dalbeth MD) Correspondence to: Prof Tony R Merriman, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35233, USA tony.merriman@otago.ac.nz Background There is a paucity of data on outcomes for people with gout and COVID-19. We aimed to assess whether gout is a risk factor for diagnosis of COVID-19 and COVID-19-related death, and to test for sex- and drug-specific differences in risk. Methods We used data from the UK Biobank, which included 15 871 people with gout. We used multivariable-adjusted logistic regression in the following analyses using a case-control study design: to test for an association between gout and COVID-19 diagnosis in the entire UK Biobank cohort (n=459 837); to test for an association between gout and COVID-19-related death in people who were known to have died or survived with COVID-19 (n=15 772); to test for an association between gout and COVID-19-related death in the entire UK Biobank cohort (n=459 837); and to assess risk of COVID-19-related death in a subset of patients from the UK Biobank cohort with prescription data, stratified by prescription of urate-lowering therapy and colchicine (n=341 398). Models 1 and 2 were adjusted for age group, sex, ethnicity, Townsend deprivation index, BMI, and smoking status. Model 2 was also adjusted for diagnosis of 16 other diseases that are established comorbidities of gout or established risk factors for COVID-19-related death. Findings Gout was associated with diagnosis of COVID-19 (odds ratio [OR] 1·20, 95% CI 1·11–1·29) but not with risk of COVID-19-related death in the cohort of patients diagnosed with COVID-19 (1·20, 0·96–1·51). In the entire cohort, gout was associated with COVID-19-related death (1·29, 1·06–1·56); women with gout had an increased risk of COVID-19-related death (1·98, 1·34–2·94), whereas men with gout did not (1·16, 0·93–1·45). We found no significant differences in the risk of COVID-19-related death according to prescription of urate-lowering therapy or colchicine. When patients with gout were stratified by vaccination status, the risk of diagnosis with COVID-19 was significant in the non-vaccinated group (1·21, 1·11–1·30) but not the vaccinated group (1·09, 0·65–1·85). Interpretation Gout is a risk factor for COVID-19-related death in the UK Biobank cohort, with an increased risk in women with gout, which was driven by risk factors independent of the metabolic comorbidities of gout. Funding Health Research Council of New Zealand. Copyright © 2022 Elsevier Ltd. All rights reserved.