A method to assess the prevalence of gout in the Australian population using wastewater-based epidemiology (WBE) was established. Oxypurinol, the urinary metabolite of allopurinol, was used as a biomarker of gout disease for calculating gout prevalence from wastewater which has been used as a first-line gout preventive medication in Australia. Wastewater collected from 75 wastewater treatment plants (WWTPS) across Australia that covered approximately 52% population on the 2016 Australian census day. Oxypurinol loads were compared with a large set of wastewater-based epidemiology (WBE) biomarkers, the socio-economic index for areas (SEIFA), and disease factors to reveal the drivers of the gout disease at the population level. Allopurinol consumption ranged from 1.9 to 32 g/day/1000 people equating to 4.8 to 80 DDD/day/1000 people. It was assumed that one defined daily dose was consumed per patient each day. Results showed that the prevalence of gout ranged from 0.5 % to 8 % in different areas with a median prevalence of 2.9% nationally. No significant positive associations were found between allopurinol consumption and alcohol consumption, the mean age of catchment population, remoteness, or higher socioeconomic status. We found a significant positive correlation with naproxen (analgesic drug) consumption. Our study demonstrates that WBE can be used to estimate gout prevalence and can provide further information when triangulated with other biomarkers to evaluate disease-specific risk factors at the population level.