After adjusting age, gender, ethnicity, education levels, Townsend index, IMD, income, BMI, smoking status, drinking status, water intake,urate, ALT, AST, ALP, GGT, PRS and eGFR, articipants exposed to >200 mg/L of hard water had an 13% increased risk of gout (HR: 1.13, 95% CI: 1.07-1.20). This evidence concerns the gene GPT and gout.