Epidemiological Dynamics of Urogenital Congenital Anomalies: A Temporal and Regional Analysis from the Global Burden of Disease Study 2021

Background： Urogenital congenital anomalies (UCAs) are significant contributors to morbidity and disability worldwide, disproportionately affecting regions with limited healthcare resources ^[1] . These conditions impose a substantial burden on individuals and healthcare systems, yet their global trends and disparities remain insufficiently understood ^[2] . This study aimed to analyze temporal trends in incidence, prevalence, and Disability-Adjusted Life Years (DALYs) of UCAs across five Socio-Demographic Index (SDI) regions from 1990 to 2021, alongside a detailed assessment of disparities among 204 countries and territories. Methods: Using data from the Global Burden of Disease (GBD) Study 2021, this study extrapolated age-standardized incidence, prevalence, deaths, and DALYs for UCAs. Temporal trends were evaluated using Joinpoint regression analysis to identify salient changes. The relationship between SDI and UCA burden was analyzed through regression and frontier analysis, while ARIMA modeling was used to project future trends. Results were stratified by SDI, region, and gender, with statistical significance set at P < 0.05. Results: Between 1990 and 2021, the global epidemiological patterns of urogenital congenital anomalies (UCAs) displayed pronounced temporal and regional heterogeneity across varying SDI levels. In High SDI regions, the total mortality burden markedly declined from 1,020 deaths (95% UI: 791–1433) in 1990 to 498 deaths (95% UI: 335–652) by 2021. Concurrently, the age-standardized death rate (ASDR) decreased from 0.17 per 100,000 population (95% UI: 0.13–0.23) to 0.09 per 100,000 (95% UI: 0.06–0.12).In contrast, Low-middle SDI regions observed a reduction in deaths from 3,429 (95% UI: 1262–6649) to 2,817 (95% UI: 1442–5307) over the same period; however, ASDR values remained relatively steady, registering 0.20 (95% UI: 0.08–0.37) in 1990 and 0.19 (95% UI: 0.09–0.38) in 2021.Analysis employing Joinpoint regression identified significant trend shifts. In High SDI regions, ASIR demonstrated a significant downward trajectory between 1990 and 2003 (APC = -0.37%, P < 0.05) and further reduction from 2003 to 2014 (APC = -0.23%, P < 0.05). Notably, an inflection occurred post-2016, with ASIR increasing from 2016 to 2019 (APC = +1.53%, P < 0.05) and accelerating between 2019 and 2021 (APC = +5.94%, P < 0.001).Similarly, Low-middle SDI regions evidenced a significant ASIR decline from 1990 to 1993 (APC = -1.52%, P < 0.05) and from 1993 to 1998 (APC = -0.61%, P < 0.05), succeeded by a positive trend after 2016 (APC = +1.14%, P < 0.05).Clear sex-based discrepancies in UCA-associated mortality were observed across all SDI strata. In High SDI regions, male mortality decreased from 691 cases (95% UI: 505–1068) in 1990 to 335 cases (95% UI: 200–451) in 2021, whereas female deaths declined from 329 (95% UI: 183–536) to 163 (95% UI: 90–268) during the same interval. Correspondingly, the ASDR for males declined from 0.22 per 100,000 (95% UI: 0.16–0.34) to 0.12 per 100,000 (95% UI: 0.07–0.17), and for females from 0.11 (95% UI: 0.06–0.18) to 0.06 (95% UI: 0.03–0.10).In Low-middle SDI settings, male ASDR remained at 0.19 per 100,000 (95% UI: 0.09–0.38) by 2021, while the female ASDR was comparatively lower at 0.10 (95% UI: 0.05–0.18), suggesting persistent sex-related survival advantages.Age-specific analysis indicated that disease prevalence predominantly concentrated in the under-five age group, particularly in High SDI regions, where prevalence rates reached approximately 360 per 100,000 for females and 300 per 100,000 for males.Autoregressive integrated moving average (ARIMA) models projected differentiated trajectories of ASIR and ASDR. In High SDI areas, the ASIR is anticipated to increase from 14.4 per 100,000 (95% PI: 12.1–16.7) in 2021 to 16.2 per 100,000 (95% PI: 13.5–19.3) by 2035, predominantly driven by rising male incidence. Simultaneously, the ASDR is projected to decrease further, attaining 0.07 per 100,000 (95% PI: 0.05–0.10) by 2035 (P trend < 0.001).For Low and Low-middle SDI regions, male ASIR is forecasted to ascend from 19.8 per 100,000 (95% PI: 14.8–26.3) to 22.7 per 100,000 (95% PI: 17.2–28.4) by 2035, whereas ASDR values are expected to stabilize between 0.11–0.13 per 100,000 (95% PI: 0.08–0.16).Frontier analysis underscored significant discrepancies in Disability-Adjusted Life Years (DALYs) attributable to UCAs across 204 nations. High SDI countries, exemplified by Japan and Germany, aligned closely with the efficiency frontier, maintaining DALYs below 10 per 100,000. Conversely, Low SDI countries such as Somalia and Chad recorded DALYs exceeding 150 per 100,000, reflecting substantial deviation from optimal efficiency benchmarks (P < 0.001). Conclusion: This study presents a comprehensive evaluation of the global epidemiology and temporal trajectories of urogenital congenital anomalies (UCAs) from 1990 to 2021, utilizing data from the Global Burden of Disease Study 2021. Through Joinpoint regression, ARIMA-based projections, and frontier benchmarking, we identified substantial heterogeneity in incidence, mortality, and DALYs across development levels and sexes. Sustained mortality reductions were evident in high-SDI contexts, whereas lower-SDI settings exhibited persistent and widening differentials. These findings reflect the interplay of health system maturity, early detection, and policy responsiveness in determining UCA outcomes. Theoretically, the study offers contextualized insight into a neglected congenital subgroup; practically, it supports forecast-informed prioritization and policy targeting. Future research should address current data sparsity, integrate socioeconomic determinants, and enhance model validation in underrepresented settings to guide equitable and effective responses. Our results reinforce the urgency of bridging structural inequities in congenital anomaly control at the global scale.