We analyzed the burden of disease due to UTIs for 195 countries and territories, 21 regions, and 5 SDI quintiles from 1990 to 2017. Globally, the incident cases, death cases, and DALYs of UTIs increased by 52.09%, 140.10%, and 69.65%, respectively. The ASIR, ASDR, and ASR of DALYs all showed an upward trend. The highest ASIR was observed in New Zealand and Norway. The highest ASDR was observed in Seychelles and Barbados. These four countries showed a heavy disease burden of UTIs and indicates that disease-related preventive measures and treatment methods need to be improved. India and China have the highest number of incident cases in 2017. However, the ASIR showed a decrease in China, which may be related to the huge population base, aging and expansion of medical care coverage.
Our results also showed that ASIR was highest in the high SDI quintile and lowest in the low SDI quintile, and showed a positive correlation with SDI. To some extent, living habits and environment may play a role. More importantly, there may be numerous patients with UTIs who did not choose regular medical treatments or some areas do not have medical conditions to provide the correct diagnosis and record it. On the contrary, ASDR were highest in low SDI quintile and lowest in high-middle SDI quintile. This indicates that areas with relatively high SDI values may have superior medical resources, and it also proves the hypothesis that areas with low SDI values may not provide sufficient diagnostic and treatment resources. Therefore, these data from countries and regions with insufficient medical conditions, which may mention us should be put more attention and analyses.
In 2017, the incidence cases of UTIs in females were 3.44 times higher than males, the deaths cases were 1.31 times higher, and DALYs was 1.21 times higher. These results were consistent with previous published studies, which have found there was approximately 30–44% of females would have a recurrent UTIs within six months of an initial infection(12, 13). Obviously, recurrent UTIs incur a huge economic burden each year due to prevention and treatment (14). The high incidence and recurrence rate of females may relate to many factors, such as physiological structure of the female urinary tract, changes in the acidic environment of the vagina caused by age-related decline in estrogen levels, genetic factors and pregnancy status(15). In a word, the formulation of preventive strategies for female patients is of practical significance for reducing the burden of disease caused by UTIs.
Infants, who is younger than 1 year old, have a higher incidence rate of UTIs, and females were higher than males of them in 2017 (2.88% vs. 1.63%). Other studies also reported over 30% of infants and children experience recurrent infections within 6–12 months after the initial infection (16, 17), and 10%-40% children with febrile UTIs have permanent renal scarring(18, 19). The disease burden of UTIs in infants and children may be reduced by male circumcision(20), maintain perineal hygiene(21), treatment for lactating women(22). Female between 25–35 years old showed a high incidence rate of UTIs, which is also the peak period of female pregnancy. Moreover, Masinde’s study showed an estimated 17.9% and 13.0% of pregnant women had symptomatic UTIs and ASB, respectively(23). As we know, UTIs during pregnancy can have adverse outcomes for both pregnant women and fetuses. Hence, rational use of antibiotics not only reduces the disease burden of urinary tract infections, but also reduces antibiotic resistance and drug side effects.
Although GBD 2017 provide comprehensive data about the global disease burden of UTIs, it still has some limitations. First, the data has not yet covered all regions of the world, relevant studies in these regions remain needed, also may provide methodological help for them. Second, since there were differences in the diagnostic methods in different regions, the data may not be very accurately reflecting the burden of UTIs in individual areas, and we suggest to unify the diagnostic methods and training before perform in future investigation. Third, current GBD study lack of specific classification data such as complex and non-complexity UTIs, and specific groups such as pregnant women and hospitalized elder. Hence, we suggest adding more disease-related information in the GBD database to facilitate a more comprehensive assessment of the burden of disease caused by UTIs.