Mortality and Causes of Death in Boys and Men Born With Hypospadias: A Swedish Population-Based Cohort Study.

INTRODUCTION

Although hypospadias is not a life-threatening condition, studies have found perinatal factors and comorbidities which could increase mortality. We aimed to investigate mortality and causes of death in boys and men born with hypospadias.

METHODS

We created a cohort of almost 3 million individuals including 16,890 with hypospadias using Swedish registers. We used Cox regression analysis to measure associations between hypospadias and all-cause mortality in different age groups (maximum age 65 years) as well as cause-specific mortality in adolescents and adults.

RESULTS

We found associations between hypospadias and mortality in infancy (HR 2.07, 95% CI: 1.74-2.45), childhood (HR 1.77, CI: 1.34-2.33), and adolescence and adulthood (HR 1.31, CI: 1.11-1.56), with stronger associations for proximal hypospadias. Controlling for birth weight and congenital comorbidity significantly reduced the association in infancy. The association was lower in younger adults (HR 1.22, CI: 1.00-1.50) but increased again after age 35 years (HR 1.57, CI: 1.17-2.11). We found a significant association with death due to cardiovascular disease or diabetes (HR 3.20, CI: 1.93-5.32) and kidney or urological disease (HR 5.16, CI: 2.13-12.5), but not cancer overall, suicide, or accidents.

CONCLUSIONS

While mortality overall was low, hypospadias is associated with relatively increased mortality from infancy to middle age. In early childhood, this is related to prenatal and perinatal factors. In adolescence and adulthood, the risk of death due to cardiovascular and urological disease was increased, providing further insight into long-term health in this patient group.