Incidence and risk factors of LUTS associated with benign prostatic hyperplasia among Chinese men: findings from the CHARLS cohort

China’s rapidly aging population is increasing the prevalence and economic burden of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS-BPH). However, limited national-scale evidence exists regarding incidence, regional variation, and risk factor patterns among Chinese men. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we followed 6,713 men aged ≥ 45 years who were free of LUTS-BPH at baseline (2011–2012). LUTS-BPH onset was identified through biennial surveys (2013–2018). Age- and region-specific incidence rates were calculated, and multivariable Cox proportional-hazards models were used to identify independent risk factors. During a median follow-up of seven years (38,949 person-years), 1,175 incident LUTS-BPH cases were observed, yielding an overall incidence of 30.2 per 1,000 person-years (95% CI: 28.5–31.9). Incidence increased steadily with age until 75 years and then declined slightly. Predicted cumulative risks among 45-year-old men without LUTS-BPH were 16.7%, 30.6%, and 42.2% over 10, 20, and 30 years, respectively. Significant geographical heterogeneity was observed, with higher rates in Central and southern humid regions. Independent predictors included age, body-mass index, waist circumference, education, perceived health status, smoking, napping time, and residence region.These risk factors varied across different age groups (≤ 60, 60–75, and ≥ 75). LUTS-BPH incidence in Chinese men rises with age and varies substantially by region and lifestyle. Modifiable factors such as central obesity and prolonged napping may guide early risk stratification, though causal relationships require validation in future interventional and mechanistic studies. These findings support targeted, region-specific screening strategies for China’s aging male population.