Retrospective survival analysis of feline lower urinary tract disease in China using insurance data.

Feline lower urinary tract disease (FLUTD) is a common, multifactorial, multidisease syndrome with limited data reported in Asia. We analyzed nationwide pet insurance data in China from 24/September/2023-25/February/2025 and performed disease mapping on the full insurance cohort. Using a triangulation framework, we then implemented both case-cohort and province-matched nested case-control designs to investigate associations between demographic factors and time to first FLUTD event after enrollment. We identified 8744 FLUTD claims including 7121 incident cases with a morbidity risk of 5.4% (confidence interval [CI]: 5.3 - 5.5%) and an incidence rate of 37.9 per 1000 cat-years (95%CI: 37.1 - 38.8). Disease mapping showed higher-than-expected risk in several eastern provinces/municipalities. Across both designs, males had more than a 3-fold higher hazard of FLUTD than females. Compared with British Shorthair, Maine Coon and Devon Rex had a lower hazard. Neutering showed an age-varying effect which was strongest before 2 years of age (HR 1.92, 95% CI: 1.72-2.15) but still present between 2 and 7 years of age (HR 1.23, 95% CI: 1.13-1.36) with imprecise estimates in cats ≥ 7 years. These findings support targeted prevention and early management in younger neutered cats, including owner education, diet and water-intake strategies, stress reduction, and prompt clinical assessment of urinary signs. This study provides the first large-scale Chinese evidence on FLUTD using insurance data and highlights priorities for standardized diagnostic criteria and structured electronic recording across veterinary clinics, incorporation of time-varying covariates, and broader breed representation in future research.