Disease burden and long-term trends of urinary tract infections: A worldwide report

Abstract

Background: Urinary tract infections (UTIs) are one of the most common infections worldwide, but little is known about their global scale and long-term trends. We aimed to estimate the spatiotemporal patterns of UTIs' burden along with its attributable risk factors at a global level, as well as the variations of the burdens according to socio-demographic status, regions, nations, sexes, and ages, which may be helpful in guiding targeted prevention and treatment programs.

Methods: Data from the Global Burden of Disease Study 2019 were analyzed to depict the incidence, mortality, and disability-adjusted life years (DALYs) of UTIs in 204 countries and territories from 1990 to 2019 by socio-demographic status, nations, region, sex, and age.

Results: Globally, 404.61 million cases, 236,790 deaths, and 520,200 DALYs were estimated in 2019. In particular, 2.4 times growth in deaths from 1990 to 2019 was observed, along with an increasing age-standardized mortality rate (ASMR) from 2.77/100,000 to 3.13/100,000. Age-standardized incidence rate (ASIR) was consistently pronounced in regions with higher socio-demographic index (SDI), which presented remarkable upward trends in ASMR and age-standardized DALY rate (ASDR). In contrast, countries with a low SDI or high baseline burden achieved a notable decline in burden rates over the past three decades. Although the ASIR was 3.6-fold higher in females than males, there was no sex-based difference in ASMR and ASDR. The burden rate typically increased with age, and the annual increasing trend was more obvious for people over 60 years, especially in higher SDI regions.

Conclusions: The burden of UTIs showed variations according to socio-demographic status, nation, region, sex, and age in the last three decades. The overall increasing burden intimates that proper prevention and treatment efforts should be strengthened, especially in high-income regions and aging societies.

Keywords: disparity; global burden; systematic analysis; temporal trend; urinary tract infection.

Figure 1

Number of cases and age-standardized rates of urinary tract infection burden according to sex for the period 1990 to 2019. The bar plot presented the absolute burden of urinary tract infection, and the line plot presented the age-standardized burden rate of urinary tract infection. (A) Incidence of urinary tract infection. (B) Mortality associated with urinary tract infection. (C) DALYs associated with urinary tract infection. DALYs, disability-adjusted life years; SDI, socio-demographic index; ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALY rate.

Figure 2

Global mortality of urinary tract infection for both sexes across 204 countries and territories. (A) ASMR of urinary tract infection in 2019. (B) EAPC in the ASMR of urinary tract infection from 1990 to 2019. ASMR, age-standardized mortality rate; EAPC, estimated annual percentage change.

Figure 3

Age-specific number of cases and burden of urinary tract infection according to sex in 2019. The bar plot presented the absolute burden of urinary tract infection, and the line plot presented the age-specific burden rate of urinary tract infection. (A) Incidence of urinary tract infection. (B) Mortality associated with urinary tract infection. (C) DALYs associated with urinary tract infection. DALYs, disability-adjusted life years; SDI, socio-demographic index.

Figure 4

Change in the mortality of urinary tract infection across all age groups in the worldwide and five SDI regions, both sexes, from 1990 to 2019. (A) Number of deaths. (B) Age-specific mortality rate. (C) EAPC in the age-specific mortality rate of urinary tract infection. EAPC, estimated annual percentage change; SDI, socio-demographic index.

Figure 5

Factors associated with EAPC in ASMR associated with urinary tract infection in both sexes from 1990 to 2019. (A) ASMR associated with urinary tract infection in 1990 at the national and territorial level (baseline burden). (B) SDI associated with urinary tract infection in 2019 at the national and territorial level (development status). (C) Annual changing trajectory in ASMR of urinary tract infection across 21 GBD regions according to corresponding annual SDI. The blue line was fitted by LOESS. ASMR, age-standardized mortality rate; EAPC, estimated annual percentage change; SDI, socio-demographic index.