Population-level associations between urinary tract infection and urolithiasis and related exposure factors: a systematic analysis of the Global Burden of Disease Study 2021

Urolithiasis is a common, highly recurrent urological condition that has clinically recognised links to urinary tract infection (UTI). Despite shared external exposure factors, the population-level dual-burden patterns of these conditions remains unclear. This study characterised global population-level associations and identified candidate exposure factors for both conditions using age-standardised incidence rates (ASIRs) and summary exposure values for 204 countries from the Global Burden of Disease 2021 database. Based on ASIR quartiles, 204 countries were classified into UTI-dominant, urolithiasis-dominant, and consistent areas. The distribution and temporal trend of population-level association patterns were evaluated using Spearman correlation analysis, Gaussian kernel, and the Louvain algorithm. Random forest, gamma regression, and exploratory population attributable fraction analyses assessed associations between candidate exposure factors and the global burden of both diseases. Overall, 75, 70, and 59 countries were labelled as UTI-dominant, consistent, and urolithiasis-dominant, respectively. ASIRs for both conditions were relatively higher in countries with higher income and larger proportion of older adults. The Louvain algorithm divided 50 countries with the highest combined ASIRs into 14 distinct communities. Multiple exposures were associated with population-level association patterns, and eight candidate exposure factors were identified. Our findings reveal complex geographical patterns in the burdens of UTI and urolithiasis, underscoring the need for country-specific tailored intervention strategies to the reduce burden of both diseases. while recognising the ecological nature of the analysis.