Clinical study
The distribution of serum uric acid values in a population unselected as to gout or hyperuricemia: Tecumseh, Michigan 1959–1960

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Abstract

Serum uric acid determinations were made for 6,000 study subjects from the Tecumseh Community Health Study, Tecumseh, Michigan, 1959–1960. These 6,000 subjects represent a natural population without prior selection for either hyperuricemia or gout.

Male subjects, of whom there were 2,987, had serum uric acid values ranging from 1.0 to 13.6 mg. per 100 ml. with an arithmetic mean of 4.9 mg. per 100 ml. and a standard deviation of 1.40 mg. per 100 ml. Female subjects, 3,013 in all, had serum uric acid values ranging from 1.0 to 11.6 mg. per 100 ml. with an arithmetic mean of 4.2 mg. per 100 ml. and a standard deviation of 1.16 mg. per 100 ml. The sex specific distribution curve for male subjects is broad and slightly skewed to the high value end of the scale. The curve for female subjects, by contrast, is narrow, peaking sharply at a value well below that of the curve in male subjects and is somewhat more skewed toward the upper end of the scale.

The age-sex specific mean serum uric acid values for both sexes are lowest in the four year olds with rising trend of values in the five to nine and ten to fourteen year age groups. At about puberty the curves begin to separate. The curve for male subjects continues to rise to a peak at ages twenty to twenty-four years; it then falls slightly and plateaus at a level of about 5.2 mg. per 100 ml. For female subjects, there is a slight rise in serum uric acid values beyond puberty but the curve shortly falls again and plateaus at a level of about 4.0 mg. per 100 ml. until the age of menopause, when it rises gradually to approach closely that of male subjects in the early fifties.

The data with reference to relative distribution above arbitrarily defined cutting points suggest that these points, commonly used in clinical medicine to define “hyperuricemia,” are unrealistically low and, in addition, fail to take into account important differences associated with age. The observed serum uric acid level for each individual subject has been adjusted or standardized to that of the appropriate age-sex group. The distribution curves of the present data show no suggestion of bimodality and suggest genetic polymorphism.

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The Rackham Arthritis Research Unit is supported by a grant from the Horace H. Rackham School of Graduate Studies. This study was supported by Grant CD-00005 from the U. S. Public Health Service. The Tecumseh Community Health Study is supported by the Cardiovascular Research Center (Dr. Thomas Francis, Jr., Director), The University of Michigan, under Program Project Grant H-6378 from the National Heart Institute, National Institutes of Health, U. S. Public Health Service. Reported for the Research Staff of the Cardiovascular Research Center and the Tecumseh Community Health Study, The University of Michigan, Ann Arbor, Michigan.

1

From the Rackham Arthritis Research Unit and Department of Internal Medicine, Medical School, and the Department of Epidemiology, School of Public Health, The University of Michigan, Ann Arbor, Michigan.

Present address: Department of Microbial Diseases, University Hospital, Leiden, The Netherlands.

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