Early-onset gout is associated with an increased risk of genitourinary cancers in a nationwide cohort of 6.5 million young Korean adults

Abstract Gout is prevalent among older adults, yet its incidence is increasing in younger populations. Gout has been linked to higher genitourinary cancer risk in middle-aged and older populations, but its long-term impact in early-onset gout remains unclear. We conducted a nationwide retrospective cohort study using Korean National Health Insurance Service data of adults aged 20–39 years who underwent health screenings between 2009 and 2012. Gout was defined using the International Classification of Diseases, 10th Revision code M10 and prescription records. Participants were followed up until December 31, 2023. The primary outcome was cancer incidence. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards models. Of 6,511,300 young adults, 35,946 (0.6%) had gout at baseline (mean age, 33.38 ± 4.33 years). Early-onset gout was associated with increased risks of renal (aHR 1.80), bladder (aHR 1.80), and prostate (aHR 1.63) cancers. The coexistence of gout and chronic kidney disease (CKD) substantially elevated risks of renal (aHR 5.59), bladder (aHR 7.01), and prostate (aHR 5.65) cancers, with significant interaction effects ( p < 0.01 for all). Young adults with gout have an elevated risk of prostate cancers, which is further amplified in the presence of CKD. These findings suggest that awareness of long-term oncological risk and proactive management of modifiable risk factors may be warranted in young adults with gout, particularly those with coexisting CKD.