Shan Zujuan, Chen Shun, Zhou Wenju, Yang Yingwei, Zhang Guifu, Zhao Jinquan
Department of Scientific Research Management, Honghe Hospital Affiliated to Kunming Medical University (Southern Yunnan Central Hospital), Honghe, China.
Department of Endocrinology, Honghe Hospital Affiliated to Kunming Medical University (Southern Yunnan Central Hospital), Honghe, China.
Transl Androl Urol. 2025 May 30;14(5):1363-1378. doi: 10.21037/tau-2025-44. Epub 2025 May 27.
Infertility affects one in six couples globally, with male infertility contributing to 50% of cases. Despite its high prevalence, male infertility is underexplored in some regions due to cultural and societal factors. Epidemiological data remain sparse and inconsistent. This study uses Global Burden of Disease (GBD) 2021 data to assess the global and Chinese burden of male infertility and project future trends.
Using the GBD 2021 dataset, we analyze global male infertility trends from 1990 to 2021 across different subgroups (age, region, and country), focusing on prevalence, disability-adjusted life years (DALYs), and their corresponding age-standardized rates (ASRs), and compare these trends with China. We examine the correlation between the Socio-Demographic Index (SDI) and the burden of male infertility at national and regional levels. Spearman's rank correlation assesses the relationship between ASRs and SDI. Decomposition analysis identifies drivers of the growing male infertility burden globally, in China, and across SDI regions. The slope index of inequality (SII) and the concentration index (CII) quantify global health inequalities, and the Bayesian-Aperiodic-People-Cohort (BAPC) model predicts future trends in male infertility prevalence and DALYs globally and in China.
In 2021, the global prevalence of male infertility surpassed 55 million cases, with over 300,000 DALYs. China accounted for approximately 20% of the global burden, with ASRs significantly exceeding the global average. Globally, male infertility prevalence and DALYs increased steadily from 1990 to 2021, particularly in low and low-middle SDI regions, such as South Asia, Southeast Asia, and Latin America. In contrast, China exhibited a stable trend with a gradual decline after 2008. Population growth was identified as the primary driver of global prevalence increases, while age-related factors played a more significant role in China. South and East Asia reported the highest absolute numbers of prevalence cases and DALYs, contributing to half of the global burden. However, the highest ASRs for prevalence and DALYs were recorded in Eastern Europe and Western Sub-Saharan Africa, reaching 1.5 times the global average.
This study underscores the increasing global burden of male infertility, accompanied by pronounced disparities across regions and socioeconomic groups. While the burden in China shows signs of decline, low and low-middle SDI regions continue to face rising prevalence and DALYs. Official attention, along with a comprehensive approach to managing environmental factors, lifestyle changes, and sexually transmitted diseases (STDs), is essential to address these disparities and mitigate the growing global burden of male infertility.
全球六对夫妇中就有一对受到不孕不育问题的影响，其中男性不育占所有病例的50%。尽管男性不育的患病率很高，但由于文化和社会因素，在一些地区对其研究不足。流行病学数据仍然稀少且不一致。本研究使用《2021年全球疾病负担》（GBD 2021）数据来评估全球和中国男性不育的负担，并预测未来趋势。
使用GBD 2021数据集，我们分析了1990年至2021年不同亚组（年龄、地区和国家）的全球男性不育趋势，重点关注患病率、伤残调整生命年（DALYs）及其相应的年龄标准化率（ASRs），并将这些趋势与中国进行比较。我们在国家和地区层面研究了社会人口指数（SDI）与男性不育负担之间的相关性。Spearman等级相关性评估ASRs与SDI之间的关系。分解分析确定了全球、中国以及不同SDI地区男性不育负担增加的驱动因素。不平等斜率指数（SII）和集中指数（CII）量化了全球健康不平等情况，贝叶斯非周期性人群队列（BAPC）模型预测了全球和中国男性不育患病率和DALYs的未来趋势。
2021年，全球男性不育患病率超过5500万例，伤残调整生命年超过30万。中国约占全球负担的20%，年龄标准化率显著超过全球平均水平。在全球范围内，1990年至2021年男性不育患病率和伤残调整生命年稳步上升，特别是在低和中低SDI地区，如南亚、东南亚和拉丁美洲。相比之下，中国呈现出稳定趋势，2008年后逐渐下降。人口增长被确定为全球患病率上升的主要驱动因素，而在中国，与年龄相关的因素起了更重要的作用。南亚和东亚报告的患病率病例和伤残调整生命年的绝对数量最高，占全球负担的一半。然而，东欧和撒哈拉以南非洲西部地区的患病率和伤残调整生命年的年龄标准化率最高，达到全球平均水平的1.5倍。
本研究强调了全球男性不育负担日益加重，同时各地区和社会经济群体之间存在明显差异。虽然中国的负担有下降迹象，但低和中低SDI地区的患病率和伤残调整生命年仍在上升。官方的关注以及应对环境因素、生活方式改变和性传播疾病（STD）的综合方法对于解决这些差异和减轻全球日益增长的男性不育负担至关重要。
