Global burden of male infertility from 1990 to 2021 and 15 years forecast: A cross-sectional analysis of Global Burden of Disease Study 2021.

BACKGROUND

Male infertility is a major yet understudied global health concern. This study aims to analyze the temporal trends in the global and regional burden of male infertility from 1990 to 2021, explore influencing factors, assess the relationship with sociodemographic development, analyze health inequalities, and forecast future trends.

METHODS

Using epidemiological data on male infertility from the Global Burden of Disease Study database for 1990-2021, we calculated prevalence, disability-adjusted life years (DALYs), and other indicators. Joinpoint regression, age-period-cohort analysis, and decomposition analysis were used to examine temporal trends and influencing factors. Data envelopment analysis was used to assess the relationship between male infertility and the sociodemographic index (SDI). The slope index of inequality (SII) and concentration index were used to analyze health inequalities. Autoregressive integrated moving average (ARIMA) and Bayesian age-period-cohort (BAPC) models were used to forecast prevalence from 2022 to 2036.

RESULTS

The global crude prevalence rate of male infertility was 1389.1 per 100,000 population in 2021, and the age-standardized prevalence rate was 1354.8 per 100,000 population. Among the 21 GBD regions, Eastern Europe had the highest ASPR, whereas Australasia had the lowest ASPR. Overall, prevalence showed a decreasing-then-increasing trend from 1990 to 2021, with the fastest growth occurring from 2010 to 2014. The trend of DALY changes is basically consistent with the incidence rate, with a rapid increase after 2010. The risk of infertility increased with age up to approximately 37.5 years and subsequently declined, with an overall downward trend observed after 1994. Population growth was the main driver of increasing prevalence. The increase in DALY rates is also mainly driven by population growth, contributing up to 68.06% globally, and the impact of population aging in high-SDI regions on DALY rates initially shows a significant negative effect. As SDI increased, the DALY rate generally decreased, but there was room for improvement in some countries. The inequality between high and low-SDI regions increased. Prevalence was predicted to rise in the future.

CONCLUSIONS

The global burden of male infertility is increasing overall, with lower prevalence in high-SDI regions and higher DALYs in low-SDI regions. Attention should be paid to rapidly growing populations, improving reproductive health services, and equitable access. Screening and interventions for high-risk populations should be strengthened to curb the rising prevalence trend.