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. 2025 Feb 15;15:5644. doi: 10.1038/s41598-025-90229-3

Comprehensive analysis of the global, regional, and national burden of benign prostatic hyperplasia from 1990 to 2021

Xin Chen 1,2,#, Siyuan Yang 3,#, Zhangxin He 2, Zihao Chen 2, Xinling Tang 1, Yuxin Lin 1, Yuhua Huang 1,4,✉, Jianquan Hou 1,2,4,✉, Xuedong Wei 1,4,✉
PMCID: PMC11830103  PMID: 39955408

Abstract

Benign prostatic hyperplasia (BPH) is a common urological condition affecting elderly men worldwide. In 2021, there were 112,502 (95% UI: 88,131.8–142,634.2) thousand prevalent cases globally, compared to 50,705.8 (95% UI: 38,735.5–65,693.4) thousand cases in 1990, representing a 122% increase. Over the past 30 years, the burden of BPH in low and low-middle socio-demographic index (SDI) regions have shown an upward trend and is projected to continue increasing over the next 15 years. Middle-SDI regions are facing the heaviest absolute burden of BPH. Despite declining prevalence, incidence, and disability-adjusted life years rates in high-middle SDI regions, the absolute BPH burden remains high, ranking second among the five SDI regions. In contrast, high-SDI regions exhibit a relatively low and stable BPH burden, though significant variations exist even among countries within the high-SDI category. Additionally, the global 65–69 age group bears the highest burden, with the 40–44 and 80+ age groups showing increasing trends. The burden of BPH varies significantly across regions, socioeconomic statuses, and countries, yet the absolute burden is generally increasing. The substantial regional differences in BPH burden underscore its widespread impact and potential controllability, indicating the need for more targeted healthcare efforts to address the growing BPH burden.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-90229-3.

Keywords: Benign prostatic hyperplasia, Global burden of disease study, Incidence, Prevalence, DALYs

Subject terms: Urology, Prostate

Introduction

Benign prostatic hyperplasia (BPH) is a common urological condition among elderly men. As age increases, the prostate gland enlarges, leading to a rising incidence of BPH1,2. Approximately 45% of men over 45 years of age develop BPH, with the prevalence increasing to about 80% in men over 703,4. According to the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, there were 94 million cases of BPH worldwide in 20195.

Although BPH is a non-malignant condition, many elderly men suffer from its negative impact on quality of life1. The clinical features of BPH involve the progressive development of lower urinary tract symptoms (LUTS) caused by the continuous proliferation of stromal and epithelial cells in the transition zone surrounding the urethra6. These symptoms, which include nocturia, difficulty in urination, hesitancy, and frequency, significantly reduce patients’ quality of life, impair mental health, and increase healthcare costs7–10. Furthermore, BPH can lead to adverse events such as urinary tract infections, acute urinary retention, vesical calculi, and acute renal failure11. With the aging population, the rising incidence and symptoms of BPH with age contribute to a significant increase in societal burden7.

The GBD is the largest and most comprehensive scientific effort to estimate health loss caused by 371 diseases and injuries. Since GBD 2010, the burden of BPH has been estimated and included in comprehensive reports12. However, compared to other malignant diseases, the burden of BPH has been relatively underreported, especially lacking detailed and comprehensive accounts13. In May 2024, the GBD 2021 Diseases and Injuries Collaborators published the latest data from the 2021 global disease burden study14. Understanding the comprehensive burden of BPH, its epidemiological trends, and the roles of demographic, age, and economic factors using the latest data is crucial for advancing BPH healthcare and helping health systems address the challenges associated with this increasing global burden.

Methods

Data source

The BPH data was sourced from GBD 2021, which provides the latest epidemiological estimates of the burden of 371 diseases and injuries across 21 GBD regions and 204 countries and territories from 1990 to 2021. For detailed information on this study, please refer to GBD 202114.

This study adheres to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER)15. All data and the code used for data processing and modeling are available on the Global Health Data Exchange (GHDx) website(https://ghdx.healthdata.org/gbd-2021/sources).

Disease definition

BPH cases were defined based on individuals presenting lower urinary tract symptoms due to benign prostatic obstruction and receiving the clinical diagnosis. The patient identification in this study is based on the official GBD data. Diagnoses were determined via the International Classification of Diseases, Ninth Revision (ICD-9) codes 600, 600.0, 600.1, 600.2, 600.3, and 600.9, and Tenth Revision (ICD-10) codes N40, N40.0, N40.1, N40.2, N40.3, and N40.916.

Socio-demographic index (SDI)

The SDI is a composite measure introduced by the Institute for Health Metrics and Evaluation (IHME) in 2015 to assess the development level of countries or regions, emphasizing the link between social development and population health outcomes. The SDI is calculated as the geometric mean of three indicators: the total fertility rate for women under 25 years, the average educational attainment of individuals aged 15 years and older, and the lag-distributed income per capita. These indicators are scaled from 0 to 1. In GBD 2021, 204 countries and territories are categorized into five SDI regions: low (0 to 0.2), low-middle (0.2 to 0.4), middle (0.4 to 0.6), high-middle (0.6 to 0.8), and high (0.8 to 1.0)14.

Disability-adjusted life years (DALYs) and years lived with disability (YLDs)

Disability-adjusted life years (DALYs) are a standard metric used to quantify the burden of disease. They represent the total number of years of healthy life lost due to a disease or condition, combining both years of life lost (YLLs) and years lived with disability (YLDs). The formula to calculate DALYs is: DALYs = YLLs + YLDs. YLDs due to BPH are estimated by multiplying disability weights by the prevalence of symptomatic and asymptomatic BPH and summing them. Asymptomatic BPH is often included in the calculation of YLD in GBD study because the methodology aims to account for the overall disease burden, which includes both symptomatic and asymptomatic cases. As there is no mortality attributable to BPH, there are no years of life lost (YLLs) due to BPH. Consequently, DALYs are equal to YLDs. Thus, in this study, we only study the DALYs measure5.

Age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDR)

In this study, age-standardized rate (ASR) of BPH burden (per 105 population), including ASPR, ASIR and ASDR was calculated using the formula:

graphic file with name 41598_2025_90229_Article_Equa.gif

where ai denotes the age-specific rate in the ith age subgroup and wi represents the number of individuals in the same age class of the GBD world age-standard population14,17.

Estimated annual percentage change (EAPC) and percentage change

EAPC is an effective and widely used indicator for tracking trends in metrics such as prevalence and incidence over specific periods18. This study aims to estimate the dynamic trends of BPH prevalence, incidence, and DALYs from 1990 to 2021. The calculation of EAPC is based on fitting a regression model to the natural logarithm of rates, using time as the variable, fitting each observation’s natural logarithm to a straight line, and calculating based on the slope of this line:19,20

graphic file with name 41598_2025_90229_Article_Equb.gif
graphic file with name 41598_2025_90229_Article_Equc.gif

x—year, y—the natural logarithm of rates (such as prevalence and incidence rates), α—the intercept, β—the slope, ε—the random error. The 95% confidence intervals (CI) of the EAPC are also derived from this fitted model21. This study also uses percentage change to reflect the variations in prevalence, incidence, and DALYs cases in 2021 compared to 1990 (Percentage change = (2021 cases − 1990 cases)/1990 cases).

Correlation analysis

Correlation analysis is a statistical technique employed to examine the linear relationship between two variables by computing the correlation coefficient. This coefficient is a standardized measure that quantifies the strength and direction of the linear relationship between the variables. In this study, the cor.test function in R was utilized to calculate the correlation coefficients between ASR and SDI across 21 regions or 204 countries. The findings were presented using scatter plots with an accompanying trend line22.

Forecasting the BPH over the next 15 years using the auto regressive integrated moving average (ARIMA) model

To forecast the progression of a disease over the next 15 years (2022 to 2036), we used the ARIMA model, a popular method for time series analysis. The fundamental principle of ARIMA involves differencing the time series to convert a non-stationary series into a stationary one, followed by modeling this stationary series. The ARIMA model is characterized by three primary parameters: p, d, and q. Specifically, p denotes the order of the autoregressive term, d signifies the order of differencing, and q indicates the order of the moving average term. To determine these parameters, we utilized the autocorrelation function (ACF) and partial autocorrelation function (PACF). The forecasting approach aids us in better understanding potential trends and in planning interventions accordingly23.

Joinpoint regression analysis

Analyzing long-term trends is crucial for understanding disease prevalence, incidence, and DALYs data. We performed joinpoint regression analysis using the Joinpoint Regression Program version 4.9.1.0 (National Cancer Institute, Rockville, MD, USA) to assess the prevalence, incidence, and DALY rates of BPH. Joinpoint regression analysis used logarithmic transformation of the rates and binomial approximation to calculate standard errors4. When the P-value was greater than 0.05, there were no significant changes in the prevalence, incidence, DALYs of BPH of BPH during this time24. Monte Carlo methods were employed to determine P-values, and Bonferroni corrections were used to asymptotically maintain the overall significance level.

Decomposition analysis

The decomposition analysis was conducted to identify the primary factors influencing the changes in the BPH burden between 1990 and 2021. This study sought to quantify the separate effects of population growth, aging, and epidemiological changes on the prevalence, incidence and DALYs measure. The methodology involves assessing the impact of each factor independently while maintaining the other two factors as constants25.

Data processing and visualization

Data cleaning, computation, and graph plotting were conducted using R software (version 4.3.1). Visualizations were created using the ggplot2 package, and final editing was done using Adobe Illustrator software (version CS5). This study adhered to the Strengthening the Reporting of Cohort Studies in Surgery (STROCSS) guidelines for observational studies in its protocol development, execution, and reporting26.

Results

Global level

Globally, there has been a marked rise in the prevalent, incident, and DALYs cases associated with BPH. Specifically, the number of prevalent cases surged from 50,705.8 (95%UI: 38,735.5–65,693.4) thousand in 1990 to 112,502 (88,131.8–142,634.2) thousand in 2021, reflecting a 122% increase. Similarly, incident cases grew from 6,406 (95%UI: 4,999.9-7,994.8) thousand in 1990 to 13,787.6 (95%UI: 10,907.9–17,015) thousand in 2021, representing a 115% rise, while DALYs rose from 1,011.1 (95%UI: 605.8-1,555.9) thousand in 1990 to 2,235.7 (95%UI: 1345.7-3402.6) thousand in 2021, showing a 121% increase. Despite no significant changes in the global prevalence, incidence, and DALY rates for BPH from 1990 to 2021, with EAPC of − 0.008 (95%CI: − 0.056 to 0.041), 0.033 (95%CI: − 0.017 to 0.082), and − 0.003 (95%CI: − 0.053 to 0.047), the overall trend indicates a continuous increase in the total burden of BPH worldwide (Supplementary Tables S1-S3).

SDI regional level

In 2021, the middle SDI regions reported the highest absolute numbers of prevalent, incident and DALYs cases of BPH, with 18,779.4 thousand (95% UI: 15,540.5 to 22,785.8), 2,083.5 thousand (95% UI: 1,716.9 to 2,523.2), and 769.6 thousand (95% UI: 459.7 to 1,179.4) cases, respectively. Furthermore, these cases accounted for approximately one-third of the global total (Supplementary Tables S1-S3). The middle SDI regions show the largest percentage change (approximately 162%) from 1990 to 2021. In contrast, the high-middle SDI regions exhibited the smallest percentage change (approximately 90%). From 1990 to 2021, the EAPC in disease prevalence, incidence, and DALYs rates has exhibited a rising trend in low SDI regions and low-middle SDI regions. Conversely, a downward trend is noted in the high-middle SDI regions with the most pronounced decline. This trend diminishes significantly in high SDI regions, approaching a negligible rate. In 1990, the highest rates of prevalence, incidence, and DALYs were shown in the high-middle SDI regions and the lowest rates were shown in the high SDI regions. As of 2021, the low-middle SDI regions have seen the highest rates of disease prevalence, incidence, and DALYs. The high-middle SDI regions have declined to the third position, while the high SDI regions still exhibit the lowest rates (Fig. 1, Supplementary Figs. S1, S2).

Fig. 1.

Fig. 1

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Temporal trend of benign prostatic hyperplasia burden in global and 5 SDI regions. (A) Percentage change in cases of prevalent, incident, and DALYs in 1990 and 2021. (B) The EAPC of prevalence, incidence, and DALY rates from 1990 to 2021. (C) The rates of prevalence, incidence (Figure S1), and DALYs (Fig. S2) from 1990 to 2021. SDI socio-demographic index, EAPC estimated annual percentage change, DALYs disability-adjusted life years.

GBD regional level

In 2021, the Eastern Europe regions reported the absolutely highest prevalent, incident and DALYs rate of BPH, with 6,262.2 (4821.1-7834.3)/100,000, 661.1 (527.1-792.2)/100,000, and 123.6 (75.4-185.1)/100,000, respectively. Among the regions mentioned, Andean Latin America exhibited the greatest percentage change (prevalence: 2.05, incidence: 1.98, DALYs: 2.04), while Central Europe showed the smallest percentage change (prevalence: 0.36, incidence: 0.29, DALYs: 0.36) in health metrics over the years leading up to 2021. Over the past 32 years, consistent increases in prevalence rates, incidence rates and DALYs rates have been observed in more than half of the regions except that high-income Asia Pacific, Tropical Latin America, Central Europe, Southeast Asia, East Asia (Fig. 2, Supplementary Figs. S3, S4).

Fig. 2.

Fig. 2

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Temporal trend of benign prostatic hyperplasia burden in regions. (A) Prevalence, incidence (Fig. S3), and DALYs (Fig. S4) rate per 100,000 population in 1990 and 2021. (B) Percentage change in cases of prevalent, incident, and DALYs in 1990 and 2021. (C) EAPC of rates of prevalent, incident, and DALYs from 1990 to 2021. SDI socio-demographic index, EAPC estimated annual percentage change, DALYs disability-adjusted life years.

Countries level

From 1990 to 2021, the majority of countries demonstrated an upward trend in the prevalence, incidence, and DALYs cases related to BPH. The most significant percentage changes were noted in Qatar (prevalence = 9.261, incidence = 9.691, DALYs = 9.188) and the United Arab Emirates (prevalence = 13.812, incidence = 15.052, DALYs = 13.846), both classified as high SDI regions. This contrasts sharply with the notably lower percentage changes observed in other high SDI regions, highlighting a polarizing trend in BPH case increases within these countries (Fig. 3 and Supplementary Fig S5-S8, Supplementary Tables S4-S6).

Fig. 3.

Fig. 3

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Temporal trend of benign prostatic hyperplasia burden in countries level. (A) Percentage change in prevalent, incidence (Fig. S5), and DALYs (Fig. S6) cases across 204 countries in 1990 and 2021. (B) EAPC in prevalent, incidence (Fig. S7), and DALYs (Fig. S8) rates across 204 countries from 1990 to 2021. EAPC estimated annual percentage change, DALYs disability-adjusted life years. Figures were created by R 4.3.2 software (https://www.r-project.org). The world map was made using R packages including “ggmap” for map visualization, “rgdal” for spatial data handling, “maps” for geographical data.

The highest three countries in EAPC for the prevalence rates, incidence rates, and DALY rates were Spain (prevalence: 0.523; incidence: 0.631; DALYs: 0.533), Luxembourg (prevalence: 0.472; incidence: 0.599; DALYs: 0.489), Austria (prevalence: 0.568; incidence: 0.722; DALYs: 0.582). The lowest three countries in EAPC for the prevalence rates, incidence rates, and DALY rates were Poland (prevalence: − 0.823; incidence: − 0.789; DALYs: − 0.796), New Zealand (prevalence: − 0.345; incidence: 0.269; DALYs: 0.329), Indonesia (prevalence: − 0.436; incidence: − 0.361; DALYs: − 0.433) (Supplementary Tables S4-S6).

Age pattern

The prevalence, incidence, DALYs number associated with BPH is distributed among men aged more than 40 years and the highest number of prevalence, incidence, DALYs associated with BPH is in 65–69 years age groups globally. Between 1990 and 2021, the number of prevalent cases of BPH increased rapidly in all age groups. The percentage change in the number of prevalence, incidence, and DALYs of BPH in global and SDI regions show an overall increase with age. Over 90 age groups present the highest percentage change in the number of prevalence, incidence, DALYs number in both the global and the five SDI regions. Globally, the lowest percentage change in the number of prevalence and DALYs of BPH is exhibited by the 50–54 age group at 79%, 79%, the lowest percentage change in the number of incidences of BPH is exhibited by the 40–44 age group at 75%. Meanwhile, the 95 + age group exhibited the highest percentage change, with 486%, 423%, and 467%, respectively (Fig. 4, Supplementary Fig S9-S10).

Fig. 4.

Fig. 4

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Temporal trend of benign prostatic hyperplasia burden by age pattern in global and 5 SDI regions. (A) Global age-specific distribution of benign prostatic hyperplasia prevalence, incidence (Fig. S9), and DALYs (Fig. S10) cases. (B) Prevalent cases of 12 age groups (5-year intervals) from 1990 to 2021 globally and 5 SDI regions. (C) Percentage change in prevalent cases of 12 age groups globally and in 5 SDI regions from 1990 and 2021. (D) EAPC of prevalent rates of 12 age groups globally and in 5 SDI regions from 1990 to 2021. SDI socio-demographic index, EAPC estimated annual percentage change, DALYs disability-adjusted life years.

The fastest increases in the prevalence rates and DALY rates of BPH globally were observed in the 90–94 age group from 1990 to 2021, with an EAPC of 0.181 and 0.189. Furthermore, the fastest increases in the incidence rates of BPH globally in the 85–89 age group from 1990 to 2021, EAPC of 0.328. Across the five SDI regions, the EAPC in BPH cases shows diverse trends with age. It is noteworthy that in high SDI regions, the prevalence, incidence, and DALYs rates for the 40–44 age group have significantly increased (Fig. 4, Supplementary Fig S9-S10, and Supplementary Table S7-S9).

The association between BPH burden and SDI

In this study, a scatter plot with trend lines was used to explore the correlation between BPH burden and the SDI across 21 regions and 204 countries. The results reveal that BPH prevalence, incidence, and DALYs rates increase as the SDI value rises up to 0.45. Between an SDI value of 0.45 and 0.75, these rates plateau at their highest levels. However, when the SDI value exceeds 0.75, the indicators begin to decline. Regions such as Central Latin America and Western Europe have a higher burden than expected, while regions such as Southern Latin America and high-income Asia Pacific have a lower burden than expected. The burden of BPH in Lithuania, Ukraine, Russia, Estonia, Latvia, and Moldova greatly exceeds expectations, whereas in South Korea, Singapore, Brunei, Japan, Argentina, and Uruguay, the burden is significantly lower than anticipated (Fig. 5 and Supplementary Figs. S11-S18).

Fig. 5.

Fig. 5

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The associations between the SDI and prevalent, incidence (Fig. S11), and DALYs (Fig. S12) rates per 100,000 population of benign prostatic hyperplasia across 21 GBD regions. SDI Socio-demographic index, GBD Global burden of disease.

Forecasting the next 15 years’ trends

Based on the ARIMA model, the projected trend for the BPH burden over the next 15 years reveals that the ASR of prevalence, incidence, and DALYs are expected to increase primarily in regions with low, low-middle, and middle SDI levels. However, in regions with high-middle and high SDI levels, the ASRs are predicted to remain stable. This suggests that the burden in low, low-middle, and middle SDI regions may rise in the future, warranting increased attention and proactive measures (Fig. 6).

Fig. 6.

Fig. 6

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ASPR, ASIR and ASDR of benign prostatic hyperplasia in global and 5 SDI regions from 1990 to 2035. ASPR age-standardized prevalence rate, ASIR age-standardized incidence rate, ASDR age-standardized DALYs rate.

Joinpoint regression model

We utilized the joinpoint regression model to identify changes in the phase trends of the global burden of BPH. Figure 7 and Supplementary Figs. S19-S20 illustrates the trends over three decades in the prevalence, incidence, and DALYs associated with BPH. Generally, the ASPR, ASIR, ASDR shown an overall downward trend in Global and SDI regions except the low SDI regions from 1990 to 1994. Furthermore, the ASPR, ASIR, ASDR shown an overall upward trend in Global and SDI regions except the high-middle SDI regions from 1995 to 2021.

Fig. 7.

Fig. 7

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The trends of ASPR, ASIR (Fig. S19) and ASDR (Fig. S20) of benign prostatic hyperplasia in global and 5 SDI regions from 1990 to 2021. ASPR age-standardized prevalence rate, ASIR age-standardized incidence rate, ASDR age-standardized DALYs rate (*p < 0.05).

Globally, there is a discernible declining pattern in BPH prevalence, incidence and DALYs from 1990 to 1994. The APC for global prevalence, incidence and DALYs from 1990 to 1994 was − 1.52, -1.25 and − 1.46. After 1995, except the high-middle SDI countries, the significant joinpoint of prevalence, incidence and DALYs associated with BPH exhibited an overall upward trend (Fig. 7, Supplementary Figs. S19, S20). This indicates that since 1995, the burden of BPH has actually increased in all regions except high-middle SDI regions, though the extent of the increase may vary. In 2020, a suddenly decreasing trend of prevalence, incidence and DALYs were shown which may be caused by the occurrence of the covid-19.

Decomposition analysis

Through decomposition analysis of the original prevalence, incidence, DALYs for BPH, this study evaluated the effects of aging, population growth, and epidemiological shifts on BPH from 1990 to 2021. Globally, and across all SDI regions, DALYs exhibited an upward trend, most notably in the middle-SDI regions. Global population growth and aging are the main factors contributing to the increased burden of BPH in global. The impact of population growth is particularly significant in low SDI and low-middle SDI regions. These areas typically have higher birth rates and faster population growth, leading to an increased burden of BPH. Aging is primarily observed in middle SDI and high-middle SDI and high SDI regions. These areas typically have higher life expectancy and a larger proportion of elderly populations, leading to an increased burden of BPH (Fig. 8).

Fig. 8.

Fig. 8

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Prevalence, incidence, and DALYs cases for benign prostatic hyperplasia due to population growth, population ageing, and epidemiological change, in global and 5 SDI regions from 1990 to 2021.

Discussion

With an aging global population, the rising incidence and symptoms of BPH have significantly increased the societal burden7. Understanding the comprehensive impact of BPH, its epidemiological trends, and the influence of demographic, age, and economic factors using the latest data is crucial for advancing BPH healthcare and addressing the associated challenges. However, compared to other diseases, the burden of BPH has been relatively underreported, particularly lacking in detailed and comprehensive analysis13. This study utilizes data from the GBD 2021 report to provide a thorough analysis of BPH burden from 1990 to 2021, examining trends across time, geography, age, the relationship with the SDI, decomposition analysis, and future projections. In 2021, there were 112,502 thousand prevalent cases globally, compared to 50,705.8 thousand cases in 1990, representing a 122% increase. Over the past 30 years, the burden of BPH in low and low-middle SDI regions has shown an upward trend and is projected to continue increasing over the next 15 years. Middle-SDI regions are facing the heaviest absolute burden of BPH. Additionally, the global 65–69 age group bears the highest burden, with the 40–44 and 80 + age groups showing increasing trends. The burden of BPH varies significantly across regions, socioeconomic statuses, and countries, yet the absolute burden is generally increasing. The substantial regional differences in BPH burden underscore its widespread impact and potential controllability, indicating the need for more targeted healthcare efforts to address the growing BPH burden.

Globally, there has been a marked rise in the number of prevalent and incident BPH cases, as well as disability-adjusted life years (DALYs) associated with the condition. Although global prevalence, incidence, and DALY rates for BPH have not significantly changed from 1990 to 2021, the overall trend indicates a continuous increase in the total burden of BPH worldwide. This suggests that the increasing burden of BPH is primarily driven by population growth and aging, rather than an increase in disease risk factors. These findings align with previous studies based on GBD 2019 data5.

An analysis across five SDI regions revealed that the absolute burden of BPH is rising in all regions. The middle-SDI regions bear the heaviest absolute burden, with the most significant increase, likely due to rapid population growth over the past 30 years. Interestingly, from 1990 to 2021, low-SDI and low-middle SDI regions showed an upward trend in the EAPC in BPH prevalence, incidence, and DALYs rates. This suggests that, in addition to the burden from population growth, those regions may also be experiencing an increase in BPH due to changing living conditions and greater exposure to risk factors (e.g., metabolic syndrome, obesity)27–29. Furthermore, overall improvements in healthcare might have led to increased diagnosis and detection rates over time30.

Conversely, high-middle SDI regions exhibited a downward trend in BPH prevalence, incidence, and DALYs rates. The decline in DALYs rates may reflect the increased effectiveness of treatments, advances in surgical care, and improved accessibility resulting from higher economic levels6,31. Additionally, the reduction in prevalence and incidence may be attributed to improvements in dietary and health awareness, increased disease prevention measures, and better control of upstream risk factors driven by economic and educational advancements. In high-SDI regions, this trend weakens significantly, with rates approaching negligible levels. This could be because these regions already have the lowest BPH prevalence, incidence, and DALYs rates, and there have been no substantial advances in the prevention, diagnosis, or treatment of BPH1. A review comparing new drugs approved or studied for BPH since 2008 with those approved before 2008 found no new drug or combination to be superior to traditional α-blockers32. Further research into the mechanisms of BPH is essential to improve prevention, diagnosis, and treatment strategies, ultimately addressing the increasing BPH burden associated with aging.

Despite the high-SDI regions showing the lowest and most stable absolute burden of BPH among the five SDI categories, further regional analysis reveals an overall increasing trend in areas dominated by high-SDI regions, such as high-income North America, Western Europe, and Australasia. On a national level, Qatar and the United Arab Emirates, both categorized as high-SDI regions, exhibited the most significant percentage increases. This stands in stark contrast to the much lower percentage changes observed in other high-SDI regions, suggesting that even among high-income countries with similar economic development and age structures, the burden of BPH can vary significantly, with some countries experiencing a polarization trend. In recent years, the dietary patterns in Qatar and the United Arab Emirates have gradually shifted towards higher-fat, high-calorie foods, and these countries have high obesity rates. This may be a significant factor contributing to the increased burden of BPH in both countries33,34. This trend is evident in the scatterplot showing the relationship between SDI and BPH burden, where countries like Lithuania, Ukraine, Russia, Estonia, Latvia, and Moldova have a BPH burden far exceeding expectations, while South Korea, Singapore, Brunei, Japan, Argentina, and Uruguay have a much lower-than-expected burden. These findings highlight the broad relevance of BPH and its control measures, underscoring the need for enhanced efforts to address this public health challenge5. For example, public health campaigns aimed at raising awareness of BPH symptoms and promoting early diagnosis, as well as implementing lifestyle interventions related to reducing obesity to lower BPH risk, could be effective strategies6,29. Moreover, these trends reflect the potential controllability of BPH burden, suggesting that the health policies of low-burden countries might offer valuable insights. In future projections over the next 15 years, the BPH burden in low-SDI regions is expected to continue growing rapidly, necessitating effective control measures.

Additionally, from an age-specific perspective, the absolute burden is increasing across all age groups from 40 to 95+ years. The 65–69 age group bears the heaviest burden, a finding consistent with previous studies35. This phenomenon may be attributed to a combination of aging, the increased prevalence of comorbidities (such as obesity and metabolic syndrome), and changes in sex hormone levels. As men age, the risk of developing BPH increases. However, at very advanced ages, a decline in sex hormone levels may reduce the burden compared to the 65–69 age group. Men in this age group should receive enhanced BPH-related healthcare and be prioritized in relevant healthcare policies to prevent complications and reduce the burden associated with severe BPH. These healthcare measures could include enhancing health education targeted at men in this age group, encouraging greater awareness of the early symptoms of BPH. Emphasizing the importance of lifestyle changes, seeking medical advice in a timely manner, and early pharmacological intervention could help prevent progression to more severe forms of BPH. Age is widely recognized as a significant factor in the histological and clinical development of BPH, with the risk of BPH increasing with age36. The observed decrease in absolute disease burden after age 80 might be attributed to the effectiveness of early treatment. Another key factor in the pathology of BPH is sex hormones, which are associated with the onset and progression of BPH37. Although the exact molecular etiology remains unclear, sex steroids play a role in the development and maintenance of BPH38. In men, age-related changes in steroid hormones are less pronounced, but there is a significant age-related decline in serum total testosterone (T), free T, and dehydroepiandrosterone sulfate (DHEAS), which may contribute to the decreased BPH burden after age 8039,40. Despite the lower absolute burden, BPH continues to rise in patients over 80 years old, both in percentage change and rate. This increase may result from aging and longer life expectancy. Notably, in high-SDI regions, the prevalence, incidence, and DALY rates for the 40–44 age group have increased significantly, potentially indicating a trend toward younger onset of BPH.

The significant burden of BPH brings with it a substantial economic impact. In 2006, the UK spent £44 million on primary care, £69 million on medication, and £101 million on treating BPH-related complications41. In 2019, an estimate reflecting U.S. Medicare costs reported that global healthcare costs for BPH reached $73.8 billion annually42. The financial impact of BPH has escalated sharply and will continue to rise, underscoring the urgent need for strengthened interventions to control the BPH burden.

Our study has some limitations. First, the GBD data sources are limited and do not cover all populations or regions, so the data represents only an approximation for certain areas. Second, the quality of the data varies, with heterogeneity possibly due to differences in diagnostic criteria, detection methods, and surveillance systems in regions with varying levels of development. The potential biases arising from regional disparities in diagnostic practices and data quality, as well as the impact of cultural and healthcare access differences on data interpretation, are important limitations of our study. Third, due to the limitations of the disease definition provided by GBD, the burden of the disease may be underestimated. ARIMA-based projections assume the continuity of underlying trends and may not account for potential changes arising from medical advancements, policy shifts, or unforeseen global events, such as the COVID-19 pandemic.

Conclusion

The burden of BPH varies significantly across regions, socioeconomic statuses, and countries, yet the absolute burden is generally rising. Population growth, aging, and epidemiological change play different roles in the increasing BPH burden across regions. In low-SDI and low-middle SDI regions, the BPH burden has trended upward over the past 30 years and is expected to keep rising over the next 15 years, requiring intensified efforts to curb this trend. Middle-SDI regions are facing the heaviest absolute burden of BPH. Although the prevalence, incidence, and DALY rates in high-middle SDI regions are declining, the absolute burden of BPH remains high. High-SDI regions show a relatively low and stable BPH burden compared to other SDI regions; however, significant variation exists even among high-SDI countries. This underscores both the widespread impact and the potential for controlling BPH. The overall stability in high-SDI regions suggests a lack of advances in more effective treatment options. Additionally, the 65–69 age group bears the highest BPH burden and may warrant prioritization in healthcare policies.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1 (1.8MB, pdf)
Supplementary Material 2 (3.2MB, pdf)

Acknowledgements

The authors thank all members of the GBD 2021 study. This work was supported by the Jiangsu Provincial Key Research and Development Program (No.BE2020655 and No. BE2020654), the National Natural Science Foundation of China (Grant No. 32200533), the General Program of Jiangsu Health Commission (No. H2019040), and the Gusu Health Personnel Training Project of Suzhou City (No. GSWS2019033).

Author contributions

Xin Chen and Siyuan Yang contributed equally to this work. X.C. and S.Y.: Conceptualization, Methodology, Software, Formal analysis, Investigation, Writing – Original Draft, Visualization. Z.H. and Z.C.: Methodology, Investigation, Software, Validation. Y.L.: Writing – Review & Editing, Formal analysis, Funding acquisition. Y.H., X.W., and J.H.: Data Curation, Writing – Review & Editing, Supervision, Funding acquisition, Resources, Project administration. All authors have read and agreed to the published version of the manuscript.

Data availability

All data and the code used for data processing and modeling are available on the Global Health Data Exchange (GHDx) website(https://ghdx.healthdata.org/gbd-2021/sources).

Declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This study utilized publicly available data from the Global Burden of Disease (GBD) database, which is anonymized and de-identified. Therefore, no additional ethical approval or informed consent was required.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Xin Chen and Siyuan Yang contributed equally to this work.

These authors jointly supervised this work: Xuedong Wei, Yuhua Huang and Jianquan Hou.

Contributor Information

Yuhua Huang, Email: sdfyyhyh@163.com.

Jianquan Hou, Email: xf192@163.com.

Xuedong Wei, Email: wxd0422@suda.edu.cn, Email: wxd0422@163.com.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1 (1.8MB, pdf)
Supplementary Material 2 (3.2MB, pdf)

Data Availability Statement

All data and the code used for data processing and modeling are available on the Global Health Data Exchange (GHDx) website(https://ghdx.healthdata.org/gbd-2021/sources).

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