Urogenital congenital anomalies in children under 9 years: global disease burden analysis and projections, 1990-2021.

OBJECTIVE: Urogenital congenital anomalies (UGCAs), including congenital anomalies of the kidney and urinary tract and external genital malformations, are major causes of early-life morbidity, preventable mortality, and long-term disability, particularly in low-resource settings. This study assessed the global burden, temporal trends, regional disparities, and future projections of UGCAs in children under 9 years using the Global Burden of Disease (GBD) 2021 dataset. METHODS: GBD 2021 data were used to estimate incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in children aged 0-8 years. Analyses were stratified by sex, age, Socio-demographic Index (SDI), region, and country. Age-standardized rates (ASRs), SDI associations, and decomposition analyses were conducted, and future trends were projected using ARIMA and Holt-Winters models. Estimates are presented with 95% uncertainty intervals (UIs). RESULTS: From 1990 to 2021, global age-standardized incidence (ASIR) and prevalence rates (ASPR) remained stable, whereas mortality and DALY rates declined. In 2021, incidence was 2026,032 (95% UI: 1417,198-2787,372), prevalence 3360,751 (2594,010-4411,084), DALYs 5122,959 (4069,356-6172,763), and deaths 58,906 (46,861-70,940). ASRs were 150.46 per 100,000 for incidence, 248.91 for prevalence, 384.10 for DALYs, and 4.41 for deaths. Females had higher ASIRs and ASPRs, while males showed higher mortality and DALY rates. Incidence and prevalence increased with age, whereas mortality declined. With increasing SDI, incidence and prevalence rose, while mortality decreased. The burden is increasingly concentrated in low-SDI regions; Southern Sub-Saharan Africa was the only region with rising mortality. CAKUT remained the predominant subtype globally. Projections indicate continued declines in mortality, with stable incidence and prevalence. CONCLUSION: Although global mortality and DALYs from UGCAs have declined, the growing burden in low-SDI regions highlights persistent inequalities and the need for targeted interventions.