Global Trends in Incidence and Burden of Urolithiasis from 1990 to 2019: An Analysis of Global Burden of Disease Study Data

Abstract

Background: Urolithiasis is among the most common urologic diagnoses globally, with substantial burden and cost on healthcare systems worldwide. Increasing evidence links urolithiasis with an array of risk factors, including diet and lifestyle trends, noncommunicable diseases such as diabetes and obesity, and global warming.

Objective: To examine geographic, temporal, and sociodemographic patterns to better understand global disease burden of urolithiasis.

Design setting and participants: We extracted data on age-standardized incidence rate (ASIR), deaths, and disability-adjusted life years (DALYs) attributed to urolithiasis for 21 regions, including 204 countries, for 1990-2019 from the Global Burden of Disease (GBD) study.

Outcome measurements and statistical analysis: Data were analyzed at the global, regional, and country levels, as well as stratified by the Socio-Demographic Index. The average annual percentage change (AAPC) was calculated to measure temporal trends across groups.

Results and limitations: Globally, total cases, DALYs, and deaths attributed to urolithiasis increased over the study period, while the age-standardized rates of these measures decreased. The age-standardized incidence of urolithiasis decreased from 1696.2 (95% confidence interval [CI] 1358.1-2078.1) cases per 100 000 population in 1990 to 1394.0 (95% CI, 1126.4-1688.2) cases per 100 000 population in 2019, with an AAPC of -0.7 (95% CI [-0.8, -0.6]). Of the GBD regions, Eastern Europe demonstrated a consistently higher ASIR of urolithiasis than all other regions, while the Caribbean had the highest AAPC. This study is limited by the available national and regional data, as described in the original GBD study.

Conclusions: Worldwide, total cases, DALYs, and deaths attributed to urolithiasis have increased since 1990, while age-standardized rates have decreased, with demonstrated regional and sociodemographic variation. Multifaceted strategies to address urolithiasis prevention and treatment are necessary.

Patient summary: In this study, we looked at trends in the global burden of stone disease using data from 204 countries from 1990 to 2019. We found that the overall burden has increased, but it varies by age, sociodemographic variables, and geographic region. We conclude that we need adaptable policies that suit the specific needs of the country to address this burden.

Keywords: Disease burden; Epidemiology; Global health; Quality of life; Urolithiasis.

Fig. 1

(A) ASIR per 100 000 population globally and by SDI quintile from 1990 to 2019. (B) ASIR per 100 000 population for 21 GBD regions from 1990 to 2019. ASIRs in 1990 and 2019 from Eastern Europe, Central Asia, Eastern Sub-Saharan Africa, and Central Sub-Saharan Africa are shown. ASIR = age-standardized incidence rate; GBD = Global Burden of Disease Study 2019; SDI = Socio-Demographic Index.

Fig. 2

ASIR of urolithiasis in 1990 in 204 countries and that in 2019 in 204 countries and territories. Note that in the published GBD results extracted for this study, Taiwan was incorporated into China and is therefore not separately indicated in these figures. ASIR = age-standardized incidence rate; GBD = Global Burden of Disease Study 2019.

Fig. 3

Global incidence rate of urolithiasis by age group and gender for 1990.

Fig. 4

AAPC of urolithiasis incidence from 1990 to 2019 in 204 countries. AAPC = average annual percentage change.

Fig. 5

(A) Relationship of AAPC of incidence with ASIR in 1990 and SDI in 2019. (B) Relationship of AAPC of DALYs with ASR of DALYs in 1990 and SDI in 2019. (C) Relationship of AAPC of deaths with ASDR in 1990 and SDI in 2019. Pearson’s R correlation coefficient and p value of significance are displayed in the top left corner. Size of circle is determined by total cases, DALYs, and deaths in each respective year for A, B, and C, respectively. AAPC = average annual percentage change; ASDR = age-standardized death rate; ASIR = age-standardized incidence rate; ASR = age-standardized rate; DALY = disability-adjusted life year; GBD = Global Burden of Disease Study 2019; SDI = Socio-Demographic Index.