Urolithiasis is characterized by the formation of stones in the urinary system that cause pain, urinary tract infections, and in severe cases, kidney failure. Given its widespread prevalence, this condition presents an economic burden on the global healthcare system. Recognition of the disease burden of urolithiasis is essential for the global community to establish proactive strategies that prevent the disease. However, comprehensive studies reporting on the incidence of urolithiasis and its impact on lives are few.
To fill this gap, researchers from the Department of Pediatric Nephrology and Rheumatology and Department of Urology, Sun Yat-Sen University, Guangdong, China in collaboration with colleagues at the Institute of Child and Adolescent Health, Peking University, Beijing, China analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Their study, led by Dr. Guohua He from The First Affiliated Hospital of Sun Yat-Sen University, Professor Tianxin Lin from Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, and Professor Yi Song from the School of Public Health at Peking University, was published in the Chinese Medical Journal and made available online on July 17, 2025.
Emphasizing the public health significance of their study on urolithiasis, senior author Dr. He says, "It is recognized as the second most expensive urological disease, with projections indicating its economic burden will continue to escalate." Analyzing the GBD 2021 data, which quantifies health loss due to diseases, injuries, and risk factors worldwide, the authors sought to define the disease burden by following the patterns and trends in urolithiasis disease globally and in China. They specifically looked at incidence, disability-adjusted life years (DALYs), and mortality trends from 1990 to 2021 among 204 countries and territories covered by the GBD study.
The authors identified an increasing trend in the total numbers of incidence, DALY, and mortality of urolithiasis globally in the past three decades. They followed the urolithiasis trends after further categorization based on age, sex, and socioeconomic status, reporting that the age-standardized incidence rate (ASIR), DALY rate (ASDR), and mortality rate (ASMR) were significantly higher in males than in females. The gender disparity represented by the male-to-female incidence rate ratio was higher in Southeast Asia. The gender inequality in ASMR and ASDR of urolithiasis decreased with an increase in socioeconomic status, emphasizing the importance of advanced healthcare and funding in disease prevention.
Globally, the ASIR, ASDR, and ASMR declined over the past three decades. However, in the last decade, the decline in ASIR was less marked in females than in males, while the ASDR and ASMR showed an increase. This is reflective of a recent increase in vulnerability of the female population.
The study shows that Eastern Europe presented the highest ASIR, ASDR, and ASMR in 2021. Notably, ASIR of urolithiasis in China was much lower than the global average, with a substantial decline in incidence and death. "This progress may be attributed to improvements in dietary habits, active health education, significant advancements in healthcare infrastructure and technology, and optimized public health strategies," shares Prof. Lin. The study describes China's multipronged approach that involved promoting health and physical activity in the general population, improving urolithiasis education and awareness in the community, and establishing a medical insurance system enabling early diagnosis and treatment of urolithiasis. Healthcare communities worldwide can learn from these strategies to lay down national and global policies that aid in reducing the disease burden of urolithiasis.
In summary, the findings from this study point to a global rise in the incidence of urolithiasis over the past 30 years, highlighting a significant gender disparity, particularly in regions of poor socioeconomic development.
Let us hope that improved understanding of the disease burden will direct global attention towards ending the gender and economic disparity in urolithiasis, enhancing care, and reducing mortality in the vulnerable population.
