Global incidence, prevalence, mortality and DALYs
In 2021, the global incidence of BPH was 137.88 × 105 (95% UI 109.08–170.15), UTI was 4491.02 × 105 (95% UI 4008.94–4998.43), and urolithiasis was 1059.84 × 105 (95% UI 883.49–1286.45). The age-standardized incidence rate (ASIR) for UTI was the highest at 5531.88 per 100,000 persons (95% UI 4965.44–6161.01) (Table 1). From 1990 to 2021, the ASIR for UTI exhibited an upward trend with EAPC of 0.15 (95% CI 0.10–0.20), while the ASIR for urolithiasis showed a decreasing trend with EAPC of − 0.87 (95% CI − 0.91 to − 0.84), and the ASIR for BPH demonstrated no statistically significant trend (Table 1, Fig. 1; Additional file 1: Table S1). In 2021, the global incidence of bladder cancer, kidney cancer, and prostate cancer was estimated at 5.40 × 105 (95% UI 4.95–5.83), 3.88 × 105 (95% UI 3.65–4.07), and 13.24 × 105 (95% UI 12.17–14.00), respectively, with the ASIR of prostate cancer (34.05 per 100,000 persons, 95% UI 31.27–36.00) higher than that of kidney cancer (4.52 per 100,000 persons, 95% UI 4.26–4.75) and bladder cancers (6.35 per 100,000 persons, 95% UI 5.80–6.85) (Table 1). From 1990 to 2021, the ASIR of kidney cancer showed a significant increasing trend with EAPC of 0.53 (95% CI 0.40–0.66), while bladder cancer and prostate cancer showed decreasing trends with EAPC of − 0.36 (95% CI − 0.41 to − 0.30) and − 0.06 (95% CI − 0.20 to 0.08) (Table 1, Fig. 1; Additional file 1: Table S2).
The EAPC of ASIR for 6 urologic diseases in global and 21 regions. ASIR age-standardized incidence rate, EAPC estimated annual percentage change, BPH benign prostatic hyperplasia, UTI urinary tract infections
Globally, in 2021, there were 1125.02 × 105 (95% UI 881.32–1426.34) prevalence of BPH, with an age-standardized prevalence rate (ASPR) of 2782.59 (95% UI 2191.58–3508.04) per 100,000 persons, surpassing the rates for UTI and urolithiasis (Table 1). From 1990 to 2021, the ASPR for UTI exhibited a significant increasing trend (EAPC = 0.15, 95% CI 0.10–0.19), while urolithiasis showed a decreasing trend (EAPC = − 0.87, 95% CI − 0.90 to − 0.84) (Table 1; Additional file 1: Table S1 and Fig S1). In the same year, the global prevalence and ASPR of prostate cancer exceeded those of bladder cancer and kidney cancer; and from 1990 to 2021, the ASPRs for all three urologic cancers demonstrated significant increasing trends, with kidney cancer showing the highest increase (EAPC = 0.98, 95% CI 0.80–1.16) (Table 1; Additional file 1: Table S2 and Fig. S1).
In 2021, an estimated 3.00 × 105 (95% UI 2.68–3.24) mortality was attributed to UTI, and approximately 0.18 × 105 (95% UI 0.14–0.21) cases died from urolithiasis globally. The age-standardized mortality rate (ASMR) for UTI exhibited a positive trend (EAPC = 1.02, 95% CI 0.95–1.10), while the ASMR for urolithiasis showed a declining pattern (EAPC = − 1.02, 95% CI − 1.24 to − 0.80) over recent decades (Table 1; Additional file 1: Table S1 and Fig. S2). In 2021, prostate cancer (12.63, 95% UI 11.16–13.55) exhibited a significantly higher ASMR compared to the other two types of cancers. However, from 1990 to 2021, all three cancers showed declining trends in ASMR with EAPC of − 0.98 (95% CI − 1.03 to − 0.94) for bladder cancer, − 0.14 (95% CI − 0.21 to − 0.07) for kidney cancer and − 1.05 (95% CI − 1.14 to − 0.95) for prostate cancer (Table 1; Additional file 1: Table S2 and Fig. S2).
Globally, UTI accounted for the highest number of DALYs among the three urologic benign diseases in 2021 (68.48 × 105, 95% UI 61.75–73.69), and it also exhibited the highest positive EAPC of the age-standardized DALYs rate (ASDR, 0.42, 95% CI 0.35–0.49) (Table 1; Additional file 1: Table S1 and Fig. S3). Among cancers, prostate cancer had the highest ASDR value (217.83, 95% UI 192.65–235.53), and all three cancers demonstrated decreasing ASDR trends from 1990 to 2021, with bladder cancer showing the most significant EAPC (− 1.19, 95% CI − 1.24 to − 1.13) (Table 1; Additional file 1: Table S2 and Fig. S3).
Regional incidence, prevalence, mortality, and DALYs
When analyzed by geographic regions, East Asia and South Asia exhibited the highest number of incidence, prevalence, mortality, and DALYs of BPH, UTI, and urolithiasis in 2021. Specifically, East Asia had the highest incidence of BPH (33.96 × 105, 95% UI 26.04–42.46), while South Asia recorded the highest incidence of UTI (1666.39 × 105, 95% UI 1466.27–1873.36) and urolithiasis (228.13 × 105, 95% UI 185.92–281.74) (Table 2). Moreover, South Asia also had the highest prevalence of BPH (261.16 × 105, 95% UI 192.77–339.67), UTI (31.69 × 105, 95% UI 27.91–35.66), and urolithiasis (8.64 × 105, 95% UI 7.01–10.65), as well as the highest death cases for UTI (0.80 × 105, 95% UI 0.66–0.90) and urolithiasis (0.04 × 105, 95% UI 0.02–0.06) (Additional file 1: Tables S3, S4). Furthermore, South Asia exhibited the highest DALYs of BPH (5.17 × 105, 95% UI 3.11–7.94), UTI (23.97 × 105, 95% UI 20.00–26.87) and urolithiasis (1.66 × 105, 95% UI 1.14–2.31) (Additional file 1: Table S5). In the year 2021, Eastern Europe exhibited the highest ASIR for BPH at a value of 661.12 per 100,000 persons (95% UI 527.06–792.25), as well as the highest ASPR at 6262.23 per 100,000 persons (95% UI 4821.08–7834.28), and ASDR at 123.56 per 100,000 persons (95% UI 75.40–185.08). Conversely, Tropical Latin America reported the highest ASIR for UTI (13,021.38 per 100,000 persons, 95% UI 11,715.27–14,448.99), ASPR (248.35 per 100,000 persons, 95% UI 223.35–276.03), ASMR (11.74 per 100,000 persons, 95% UI 10.16–12.66) and ASDR (217.07 per 100,000 persons, 95% UI 198.1–229.94). Eastern Europe also exhibited the highest ASIR for urolithiasis (3557.08 per 100,000 persons, 95% UI 2986.04–4230.09), ASPR (134.55 per 100,000 persons, 95% UI 113.03–158.80), ASMR (0.62 per 100,000 persons, 95% UI 0.56–0.72) and ASDR (22.82 per 100,000 persons, 95% UI 19.42–28.00) (Table 2; Additional file 1: Tables S3–S5 and Figs. S4–S7). Between 1990 and 2021, the burden of these three urologic benign diseases exhibited increasing trends in over half of GBD regions. High-income North America and Southern Latin America experienced the most significant increases in BPH burden. The greatest rise in UTI burden was observed in Central and Southern Latin America, while Tropical Latin America saw the highest increase in urolithiasis burden (Fig. 1; Additional file 1: Figs. S1–S3).
In 2021, Western Europe exhibited the highest incidence (1.22 × 105, 95% UI 1.11–1.30), prevalence (7.09 × 105, 95% UI 6.56–7.53) and mortality (0.48 × 105, 95% UI 0.42–0.51) of bladder cancer, while East Asia had the highest DALYs (9.70 × 105, 95% UI 7.75–12.24). For kidney cancer, Western Europe recorded the highest incidence (0.82 × 105, 95% UI 0.76–0.87) and mortality (0.33 × 105, 95% UI 0.29–0.35), whereas high-income North America had the highest prevalence (4.12 × 105, 95% UI 3.89–4.27) and East Asia had the highest DALYs (7.00 × 105, 95% UI 5.77–8.36). Regarding prostate cancer, high-income North America showed the highest incidence (3.16 × 105, 95% UI 2.98–3.30) and prevalence (28.29 × 105, 95% UI 26.98–29.47), while Western Europe had the highest mortality (0.86 × 105, 95% UI 0.76–0.93) and DALYs (14.43 × 105, 95% UI 12.92–15.69) (Table 2; Additional file 1: Tables S3–S5). It was noteworthy that from 1990 to 2021, kidney cancer demonstrated increasing trends in ASIR and ASPR across all GBD regions, and mortality, as well as DALY rates for kidney cancer continued to rise over time in most regions. Notably, East Asia exhibited rapid increases in both ASIR and ASPR for kidney cancer, while Southern Sub-Saharan Africa showed significant rises for both ASMR as well as ASDR (Additional file 1: Figs. S4–S7). From 1990 to 2021, there was a notable rise in ASIR and ASPR for bladder cancer across most regions, particularly pronounced in Central Europe. Conversely, a decline was observed for ASMR and ASDR, with the largest reductions occurring in East Asia. The patterns of prostate cancer closely resembled those of bladder cancer, with the most rapid increases in ASIR and ASPR observed in East Europe, North Africa, and the Middle East. Conversely, the most significant decreases in ASMR and ASDR were seen in Australasia (Fig. 1; Additional file 1: Figs. S1–S3).
National incidence, prevalence, mortality, and DALYs
In 2021, Lithuania exhibited the highest burden of BPH, with ASIR, ASPR, and ASDR reaching 691.36, 6719.37, and 132.83 per 100,000 persons respectively (Additional file 1: Table S6). Austria demonstrated the most rapid increases in ASIR, ASPR, and ASDR for BPH from 1990 to 2021, with EAPCs were 0.72 (95% CI 0.61–0.83), 0.57 (95% CI 0.45–0.69) and 0.58 (95% CI 0.46–0.70) respectively (Additional file 1: Tables S7–S10). Ecuador exhibited the highest ASIR and ASPR of UTI, with ASIR at 15,136.70 and ASPR at 288.01, while Barbados had the highest ASMR at 12.96 and Turkmenistan had the highest ASDR at 298.01 for UTI, respectively (Additional file 1: Table S6). From 1990 to 2021, Mexico showed the fastest increases in ASIR and ASPR of UTI (EAPC = 1.16, 95% CI 0.79–1.52; EAPC = 1.16, 95% CI 0.80–1.53, respectively), while Argentina demonstrated the fastest increases in ASMR and ASDR (EAPC = 7.57, 95% CI 6.52–8.62; EAPC = 6.69, 95% CI 5.82–7.58, respectively) (Additional file 1: Tables S7–S10). The highest ASIR and ASPR of urolithiasis were observed in Ukraine (ASIR: 3766.92, ASPR: 142.62), while the highest ASMR and ASDR were recorded in Kazakhstan (ASMR: 1.29, ASDR: 33.34) in 2021 (Additional file 1: Table S6). From 1990 to 2021, the most rapid increases in ASIR and ASPR occurred in Trinidad and Tobago (EAPC = 2.85, 95% CI 2.61–3.10; EAPC = 2.86, 95% CI 2.61–3.11, respectively), whereas the fastest increases in ASMR and ASDR were observed in Kuwait with an EAPC of 22.50 (95% CI 19.37–25.71), as well as Brazil with an EAPC of 2.91 (95% CI 2.66–3.17) (Additional file 1: Tables S7–S10).
In 2021, Lebanon recorded the highest ASIR of bladder cancer at 21.66 and the highest ASPR at 130.22 among three urologic cancers. Mali had the highest ASMR for bladder cancer at 8.99, while Malawi had the highest ASDR at 179.92 (Additional file 1: Table S6). The Republic of Cabo Verde exhibited the most rapid increases in ASIR, ASPR, ASMR and ASDR for bladder cancer, with EAPC of 6.19 (95% CI 4.76–7.65), 6.39 (95% CI 5.16–7.62), 5.40 (95% CI 3.94–6.88) and 5.51 (95% CI 4.05–6.99), respectively (Additional file 1: Tables S7–S10). In 2021, Argentina exhibited the highest ASIR at 15.60 and ASPR at 89.01 for kidney cancer, while Uruguay recorded the highest ASMR at 6.47 and ASDR at 170.16 (Additional file 1: Table S6). Furthermore, from 1990 to 2021, the most rapid increases in kidney cancer burden were observed in the Republic of Cabo Verde (Additional file 1: Tables S7–S10). The highest ASIR and ASPR for prostate cancer in 2021 were observed in Bermuda (ASIR: 196.12, ASPR: 1527.67), while the highest ASMR and ASDR were in Grenada (ASMR: 93.90, ASDR: 1542.79) (Additional file 1: Table S6). From 1990 to 2021, the most rapid increases in ASIR and ASPR for prostate cancer occurred in the Republic of Korea, and the fastest increases in ASMR and ASDR were seen in Georgia (Additional file 1: Tables S7–S10).
Burden of 6 urologic diseases by SDI
In 2021, the middle and low-middle SDI quintile levels exhibited higher incidence and prevalence, mortality, and DALYs of BPH, UTI, and urolithiasis. Conversely, the high and high-middle SDI quintile levels showed higher rates for bladder, kidney, and prostate cancer (Table 2; Additional file 1: Tables S3–S5). Nationally, similar associations were found between ASIR and ASPR for 6 urologic diseases with SDI across 204 countries and territories in 2021. Specifically, generally positive relationships were observed between ASIR and ASPR for 3 urologic cancers with SDI. This trend was also evident in the associations between ASIR and ASPR of UTI as well as urolithiasis with SDI. Furthermore, there were positive correlations between ASMR and ASDR of kidney cancer with SDI, while the ASDR of UTI showed slight negative correlations with SDI. No significant associations among ASMR, ASDR, and SDI were found for BPH, urolithiasis, bladder cancer, and prostate cancer (Fig. 2; Additional file 1: Figs. S8–S10).
ASIR of 6 urologic diseases for 204 countries and territories by SDI. ASIR age-standardized incidence rate, SDI sociodemographic index, BPH benign prostatic hyperplasia, UTI urinary tract infections
Burden of 6 urologic diseases by age and sex
The age distribution patterns of 6 urologic diseases were observed in 2021. Specifically, the number of incidence and prevalence as well as DALYs of BPH were predominantly concentrated in the 65–69 age group, with the highest incidence rates also occurring in the 65–69 age group, while the rates of prevalence and DALY were highest in the 75–79 age group (Fig. 3; Additional file 1: Figs. S11–S13). Both incidence and prevalence cases of UTI mainly focused on groups aged 25–34 and 0–14 years, while the deaths occurred primarily in those aged over 80 years, and DALYs were observed across both the youngest and oldest age groups. The incidence and prevalence rates of UTI were highest among individuals aged between 25 and 34 years, whereas mortality and DALY rates increased with advancing age. Urolithiasis incidence and prevalence, along with their corresponding rates, mainly affected individuals aged between 50 and 65 years, while deaths and DALYs as well as their respective rates were most prevalent among those aged over 80 years (Fig. 3; Additional file 1: Additional file 1: Figs. S11–S13). The incidence, prevalence, and DALYs of bladder, kidney, and prostate cancer were predominantly concentrated in the 70–74, 65–69, and 70–74 age groups. Conversely, deaths occurred most frequently in the 80–84, 70–74, and 80–84 age groups. Additionally, the age-specific rates for all three urologic cancers increased with age, reaching their highest values in older age groups. Notably observed was a significant decrease in the incidence and prevalence rates of kidney cancer among the elderly population (Fig. 3; Additional file 1: Figs. S11–S13).
Global incidence of 6 urologic diseases by age and sex in 2021. BPH benign prostatic hyperplasia, UTI urinary tract infections
In 2021, males constituted the primary demographic affected by urolithiasis with significantly higher incidence, prevalence, mortality, and DALYs, as well as their corresponding rates across all age groups compared to females. Conversely, females represented a more susceptible population for UTI, exhibiting substantially greater incidence and prevalence as well as higher rates compared to males. However, the mortality and DALYs associated with UTI showed a balanced between men and women (Fig. 3; Additional file 1: Figs. S11–S13). Moreover, there were distinct sex-specific patterns in the cancer burden, with higher incidence, prevalence, mortality, and DALYs of bladder and kidney cancers observed in men compared to women across all age groups globally in 2021 (Fig. 3; Additional file 1: Figs. S11–S13).
Attributable burden of urologic cancers caused by risk factors
In 2021, smoking was responsible for 26.48% (95% UI 22.78–30.40) of global deaths and 28.15% (95% UI 24.42–31.95) of DALYs related to bladder cancer, with the highest burden observed in East Asia (Table 3). Moreover, Additionally, high FPG contributed to 7.91% (95% UI − 0.99 to 18.02) of global deaths and 7.36% (95% UI − 0.93 to 16.74) of DALYs from bladder cancer in the year (Table 3), particularly impacting regions with high SDI quintiles such as high-income North America (Additional file 1: Tables S11–S12). For kidney cancer, 20.07% (95% UI 7.96–31.73) of global deaths and 19.46% (95% UI 7.76–31.03) of DALYs were attributable to high BMI, while smoking contributed to 10.06% (95% UI 6.05–14.35) of mortality and 9.53% (95% UI 5.92–13.42) of DALYs, and occupational exposure to trichloroethylene caused only a small proportion of mortality at 0.05% (95% UI 0.01–0.09) and DALYs at 0.06% (95% UI 0.01–0.12) (Table 3). In 2021, there was an increase in the prevalence of high BMI and occupational exposure to trichloroethylene compared to 1990, while the prevalence of smoking decreased (Table 3). High-BMI and smoking were associated with a higher burden of attributable mortality and DALYs for kidney cancer in regions with high SDI and high-middle SDI quintiles. Specifically, the highest burden attributable to high BMI was observed in high-income North America, while East Asia had the highest burden attributable to smoking. In contrast, occupational exposure to trichloroethylene contributed to the highest mortality and DALYs in middle SDI and low-middle SDI quintiles, such as Andean Latin America and Central Latin America (Additional file 1: Tables S11–S12). In terms of prostate cancer, smoking emerged as its primary risk factor, contributing to 3.00% (95% UI 1.42–4.92) of global deaths and 3.46% (95% UI 1.65–5.56) of DALYs in 2021 (Table 3), with the highest attributable burden observed in high-middle SDI quintiles (Additional file 1: Tables S11–S12).
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