Impact of sociodemographic development on the global burden of urological cancers attributable to modifiable risk factors, 1990–2021: A population-based study

The burden of urological cancers attributable to modifiable risk factors varies across sociodemographic contexts, yet a comprehensive assessment of the impact of development levels remains lacking. Using data from the Global Burden of Disease 2021 study, we assessed associations between the Sociodemographic Index (SDI) and age-standardized mortality rates (ASMRs) of urological cancers attributable to modifiable risk factors across 204 countries in 2021. Trends in ASMRs and disability-adjusted life year (DALY) rates from 1990 to 2021 were analyzed using estimated annual percentage change (EAPC). Mortality changes were decomposed into four components. Inequalities were quantified using the slope index of inequality (SII) and concentration index (CI). SDI was positively correlated with ASMRs for all five attributable burdens. Countries with higher SDI exhibited the highest ASMR and DALY rates. Notably, in low-middle SDI countries, bladder cancer due to high FPG and kidney cancer due to high BMI showed the steepest increases. These countries also experienced slower declines or even upward trends in smoking-attributable mortality. Decomposition revealed varying contributions of risk-deleted rates and aging. Most SDI-related inequalities widened or remained stable. Sociodemographic development critically shapes the burden of urological cancers attributable to modifiable risks, highlighting the need for development-tailored preventive strategies. • SDI was positively correlated with mortality across five urological cancers attributable to modifiable risk factors. • Higher SDI countries bore a heavier burden, while lower SDI countries showed steeply rising trends, notably for bladder cancer due to high FPG and kidney cancer due to high BMI. • Trends were driven by distinct patterns across SDI levels, especially in risk-deleted mortality and population aging. • Most SDI-related inequalities widened or remained stable over time.