Abstract

Objective

To examine the burden of benign prostatic hyperplasia (BPH) in the Middle East and North Africa (MENA) region from 1990 to 2021 by age and sociodemographic index (SDI).

Methods

Data were sourced from the Global Burden of Disease (GBD) 2021 database. We analysed the incidence, prevalence, and years lived with disability (YLDs) attributable to BPH across the MENA region and its constituent countries.

Results

In 2021, the MENA region had an estimated 4.7 million prevalent cases of BPH, with an age-standardised prevalence rate of 2168.6 per 100,000. BPH contributed to 93.6 thousand YLDs, with an age-standardised YLD rate of 42.8 per 100,000. The highest prevalence and incidence rates were observed in Jordan, Qatar, and Iran, while Egypt and Yemen recorded the lowest rates. The burden of BPH was found to increase with age, peaking in the 65鈥�69 age range.

Conclusion

This study reveals an increasing burden of BPH in the MENA region, primarily due to aging populations. These findings underscore the need for tailored public health policies and strategies to enhance early detection, prevention, and management of BPH, thereby reducing its impact on healthcare systems and individuals.

Introduction

Benign prostatic hyperplasia (BPH) stands as a highly common and financially burdensome non-cancerous tumour in men, resulting from the pathological proliferation of epithelial and stromal tissues within the prostate gland as a consequence of aging. As of 2019, the global incidence of BPH exceeded 94 million cases, an increase from 51.1 million cases in 2000 [1, 2]. Postmortem studies reveal that the age-specific prevalence of BPH is approximately 8% in individuals in their 40s, 50% in those in their 60s, and 80% among individuals in their 80s [3, 4]. BPH ranks among the top three urological conditions encountered by practitioners in low- and middle-income countries [5]. In 2019, BPH was associated with 1.86 million disability-adjusted life years (DALYs) worldwide, translating to an age-standardised DALY rate of 48.9 per 100,000 individuals [2]. The rising incidence of BPH-related urinary obstructions is concerning, particularly given the projected annual economic burden of approximately $73.8 billion [2].

While some men with BPH may remain asymptomatic, the majority will eventually develop lower urinary tract symptoms (LUTS), characterised by discomfort and functional impairment due to urethral obstruction and distortion of the bladder base. Although the symptoms of BPH are rarely life-threatening, they can significantly diminish the quality of life for affected individuals and their partners [6]. One study reported that severe LUTS can impact quality of life comparably to that of a myocardial infarction or stroke [7]. Furthermore, untreated BPH may lead to serious complications, including renal failure, renal insufficiency, and urinary retention [8].

Research suggests that racial and ethnic disparities exist in the prevalence of BPH [9]. Additionally, the risk factors linked with BPH include elevated body mass index (BMI), obesity, metabolic syndrome, dyslipidemia, cardiovascular disease, cardiac treatment history, diabetes, both acute and chronic prostatic inflammation, family history of prostatic disease, bladder cancer, erectile dysfunction, post-void residual urine volume, functional bladder capacity, educational attainment, and the use of calcium antagonists and antidepressants. Conversely, increased physical activity, moderate alcohol consumption, and smoking have demonstrated an inverse relationship with the incidence of BPH [4, 9,10,11,12,13].

Globally, the prevalence of BPH is on the rise, primarily due to aging populations. Consequently, it is anticipated that the number of men accessing healthcare services for BPH will significantly increase in the coming years. Management of upstream risk factors may help mitigate this trend. Addressing these challenges will require coordinated efforts among researchers, advocates, and policymakers at national, regional, and international levels.

The Institute for Health Metrics and Evaluation (IHME) is spearheading the Global Burden of Disease 2021 (GBD 2021) research project, which produces comprehensive data on the prevalence of diseases, injuries, and associated risk factors across 204 nations from 1990 to 2021. However, there is a notable lack of recent studies addressing the prevalence of BPH in the Middle East and North Africa (MENA) region. Therefore, the present research aims to bridge this information gap by presenting the latest data on the prevalence, incidence, and years lived with disability (YLDs) related to BPH across the 21 MENA countries and territories from 1990 to 2021, categorised by age, etiology, and sociodemographic index (SDI).

Methods

Overview

The most recent iteration of the GBD project, GBD 2021, evaluated the burden of 371 diseases and injuries across 21 regions, seven super-regions, and 204 territories and nations from 1990 to 2021 [14]. Comprehensive information on the GBD 2021 methods and advancements made since GBD 2019 can be found in other sources [14].

Case definition and data inputs

BPH is characterised as a chronic, non-cancerous enlargement of prostatic tissue, irrespective of symptomatology. The diagnosis of BPH was established using administrative data and the International Classification of Diseases, 10th Edition (ICD-10) codes [15], specifically N40, N40.0, N40.1, N40.2, N40.3, and N40.9. Consistent with GBD 2019, the model also utilised data from hospital discharges and claims, without conducting a formal literature review.

Data processing and disease model

Hospital discharge data were consisted of patient encounter records, which typically included only the primary diagnostic code for each encounter. In contrast, claims data linked all inpatient and outpatient encounters for individuals, providing both primary and secondary diagnoses. An individual was classified as a prevalent case if they had at least one inpatient or two outpatient visits within a year with a valid ICD code for any disease. To process the hospital discharge data, discharges with the appropriate ICD code as the primary diagnosis were extracted, and correction factors derived from claims data were applied. Specifically, the model was based on the proportion of inpatient claims with BPH as the primary diagnosis, relative to the total number of prevalent BPH cases identified in the claims data.

For U.S. claims data, the IHME utilised MR-BRT (Meta-regression鈥擝ayesian, regularised, trimmed) analysis to address selection bias linked to commercial insurance, following the approach undertaken in GBD 2019. For claims data outside the U.S., data points with age-standardised prevalence rates that exceeded two standard deviations from the median were considered outliers and excluded from the analysis.

In line with previous GBD publications, the age-, year-, and location-specific prevalence of BPH was estimated using DisMod-MR (version 2.1). This Bayesian mixed-effects meta-regression tool, developed by the IHME (Seattle, WA, USA), was utilised for disease modelling [14, 16, 17]. It estimated a suite of internally consistent epidemiological metrics鈥攊ncluding incidence, prevalence, excess mortality rates, remission, relative risk, and cause-specific mortality rates鈥攖hrough a compartmental model governed by age-integrated differential equations. Estimation occurred at each stage of a geographic cascade, with each model borrowing data from those preceding using Bayesian priors [14]. Each stage employed a Gaussian data likelihood function, with value priors assigned for excess mortality, remission, and incidence. Initially, it was assumed that men under 40 had no incidence of BPH, and that excess mortality rates were zero for all age groups, with a maximum disease duration of 10 years beyond 40 years old. Due to its established association with BPH, the age-standardised prevalence of diabetes was included as a predictive covariate. Previous GBD iterations had considered mean BMI as a predictor, but it was excluded from GBD 2019 due to its lack of predictive value and weak correlation with BPH [18,19,20,21,22].

The age-specific prevalence was evaluated across twelve age groups: 40鈥�44, 45鈥�49, 50鈥�54, 55鈥�59, 60鈥�64, 65鈥�69, 70鈥�74, 75鈥�79, 80鈥�84, 85鈥�89, 90鈥�94, and 95 years and older. Furthermore, the age-standardised prevalence was determined using the GBD reference population [23].

Disability weight and severity distribution

Disability weight was defined as a measure of health loss relative to an optimal health baseline, ranging from 0 (optimal health) to 1 (death). These weights for different health states were calculated using data from nine-extensive population-based surveys and an open-access online survey, where respondents evaluated pairwise combinations of health states [24,25,26]. BPH was classified into two health states: asymptomatic and symptomatic. The symptomatic state was assigned a disability weight of 0.067 (95% CI 0.043鈥�0.097), while the asymptomatic state received a disability weight of zero [27].

To estimate the proportion of BPH prevalence attributed to symptomatic health conditions, data from four community-based surveys conducted in France, Japan, Scotland, and the USA, which included males aged 40鈥�84, were analysed [28]. These surveys evaluated the severity of lower urinary tract symptoms using the International Prostate Symptom Score (I-PSS), a validated questionnaire [29,30,31]. The MR-BRT model was employed to analyse the cumulative distribution of survey respondents' I-PSS scores, determining the average percentage of individuals with symptomatic lower urinary tract symptoms. These symptomatic and asymptomatic proportions were then applied to DisMod-MR prevalence estimates to calculate the prevalence of symptomatic and asymptomatic BPH.

Compilation of results

The DALY is a commonly employed measure for quantifying the impact of a health condition, integrating the years of life lost due to early mortality with the YLD [14]. YLDs were derived by multiplying prevalence figures for each severity level by the respective disability weights assigned to those levels. Since there were no documented years of life lost (YLLs) or fatalities linked to BPH, DALYs were determined to be equivalent to the YLDs [14]. To establish uncertainty intervals (UIs) at the 95% confidence level, 1,000 iterations were executed at each computational step. These calculations accounted for uncertainties from various sources, such as input data variability, estimates of residual non-sampling error, and measurement error adjustments. The UIs were derived from the 2.5th and 97.5th percentiles of the numerically ordered samples.

The relationship between the burden of BPH, as measured by YLDs, and the SDI was analysed using smoothing splines [14]. The SDI scores ranged from 0 to 1, where 0 represented the least developed and 1 the most developed regions. These scores were computed based on factors including the fertility rate of individuals under 25, average educational attainment for those over 15, and the smoothed gross domestic product per capita over the past decade. The YLDs, along with age-standardised prevalence and incidence rates, were illustrated using R software (version 3.5.2).

Results

The MENA region

In 2021, BPH accounted for 4.7 million prevalent cases in the MENA region, with an age-standardised point prevalence of 2,168.6 (95% UI: 1,598.2 to 2,888.4) cases per 100,000 (see Table听1 and Table S1). In 2021, the age-standardised incidence rate of BPH in MENA was recorded at 250.2 (191.4 to 319.9) cases per 100,000, resulting in 604,200 (463,200 to 775,900) new cases (refer to Table听1 and Table S2). Furthermore, BPH was associated with 93.6 thousand (56.3 to 146.2) YLDs, yielding an age-standardised rate of 42.8 (25.5 to 67.5) per 100,000 individuals (see Table听1 and Table S3). Since 1990, increases were observed in the age-standardised point prevalence, incidence, and YLD rates (see Table听1 and Tables S1-3).

Table听1 Prevalence, incidence and YLDs due to benign prostatic hyperplasia in 2021 and the percentage change in the age-standardised rates during the period 1990鈥�2021

National level

In 2021, the national age-standardised point prevalence of BPH in the MENA region ranged from 2,079 to 2,436.4 cases per 100,000. The highest point prevalence were recorded in Jordan [2,436.4 (1,827.9 to 3,135.8)], Qatar [2,349.4 (1,719.2 to 3,074.9)], and Iran [2,315.2 (1,726.7 to 3,094.4)], while the lowest were seen in Egypt [2,114.7 (1,534 to 2,801.1)], Turkey [2,091 (1,536.6 to 2,758.1)], and Yemen [2,079 (1,543.8 to 2,749.7)] (see Table听1 and Table S1).

In 2021, the national age-standardised incidence rate of BPH varied from 241.8 to 277.6 cases per 100,000. The highest rates were reported in Jordan [277.6 (213.8 to 349.3)], Qatar [268.8 (205.4 to 346.1)], and Bahrain [264 (199.9 to 339.4)], while the lowest were noted in Egypt [245.6 (182.8 to 322.4)], Turkey [242.6 (184.9 to 311.7)], and Yemen [241.8 (181.4 to 308.4)] (see Table听1 and Table S2).

In 2021, the national age-standardised YLD rate of BPH in the MENA region ranged from 41.3 to 48.1 cases per 100,000. The highest rates were found in Jordan [48.1 (29.1 to 74)], Qatar [45.9 (27.7 to 71.7)], and Iran [45.8 (27.1 to 71.9)], while the lowest were observed in Egypt [41.8 (25.3 to 66.8)], Turkey [41.6 (24.8 to 65.7)], and Yemen [41.3 (24.5 to 64.6)] (see Table听1 and Table S3).

From 1990 to 2021, all MENA countries experienced increases in the age-standardised point prevalence, incidence, and YLD rates of BPH. Jordan exhibited the highest increases, with rates of 17.8% (5.4 to 36.3), 15.8% (4.1 to 33.1), and 16.6% (3.5 to 35.5), respectively. This was followed by Qatar, with increases of 9.6% (0.4 to 18.5), 8.8% (鈭�0.1 to 17.7), and 8.2% (鈭�2 to 18.1), respectively, and Bahrain, with increases of 8.6% (0.7 to 17.2), 7.7% (鈭�0.3 to 17.4), and 7.4% (鈭�0.6 to 17.5), respectively (see Table听1 and Tables S1-3).

Age pattern

In 2021, the prevalence, incidence, and YLD counts for BPH in the MENA region increased steadily with age, reaching a peak in the 65鈥�69 age range before declining in older populations (see Figs. 1, 2 and 3). The age-standardised rates, however, followed a slightly different pattern. The age-standardised prevalence rate of BPH increased progressively with age, reaching its highest point in the 75鈥�79 age range. After this peak, the prevalence rate declined as the population continued to age (Fig.听1). Similarly, the age-standardised incidence rate of BPH also showed a rising trend with advancing age, reaching its peak in the 65鈥�69 age range. Following this peak, the incidence rate began to decline, although the reduction was less pronounced in the 70鈥�75 age group. After the age of 75, the incidence rate dropped more significantly, and continued dropping until the 90鈥�95 age group, after which there again was a slight rise (Fig.听2). The age-standardised YLD rate also increased with age, reaching its peak in the 75鈥�79 age range. Beyond this age range, the YLD rate decreased steadily in older age groups (Fig.听3). In terms of overall burden, BPH YLD counts followed a similar trajectory, increasing sharply with age, reaching a peak in the 65鈥�69 age range, and then declining as age progressed. In 2021, the MENA region reported a consistently lower YLD rate for BPH compared to the global average. Furthermore, the age groups 45鈥�59 and 95 and older exhibited the highest MENA-to-global YLD rate ratios (0.9), while the age groups 40鈥�44 and 70鈥�89 had the lowest ratios (0.7). Additionally, all age groups showed equal or greater YLD rates in 2021 compared to 1990, with the exception of the 40鈥�44 age range (Fig.听4).

Fig.听1

Number of prevalent cases and prevalence of benign prostatic hyperplasia (per 100,000) in the MENA region by age in 2021; dotted and dashed lines indicate 95% upper and lower uncertainty intervals, respectively (generated from data available at )

Fig.听2

Number of incident cases and incidence rate of benign prostatic hyperplasia (per 100,000) in the MENA region by age in 2021; dotted and dashed lines indicate 95% upper and lower uncertainty intervals, respectively (generated from data available at )

Fig.听3

Number of YLDs cases and YLD rate for benign prostatic hyperplasia (per 100,000) in the MENA region by age in 2021; dotted and dashed lines indicate 95% upper and lower uncertainty intervals, respectively. YLD鈥�=鈥墆ears lived with disability (generated from data available at )

Fig.听4

The ratio of the YLD rate for benign prostatic hyperplasia in the MENA region to the global YLD rate, by age group, from 1990 to 2021. YLD鈥�=鈥墆ears lived with disability (generated from data available at )

Relationship with the socio-demographic index

The relationship between YLD rates and the SDI in the MENA region, from 1990 to 2021, was predominantly positive, indicating that the burden of BPH was greater in areas with higher socio-economic development. Countries such as Jordan, Iran, Qatar, Afghanistan, and Bahrain experienced a higher-than-expected burden of BPH. In contrast, countries including Oman, Turkey, Saudi Arabia, Lebanon, Tunisia, Kuwait, Libya, and the United Arab Emirates displayed lower-than-expected burdens (Fig.听5).

Fig.听5

Age-standardised YLD rates for benign prostatic hyperplasia across 21 countries and territories in 2021, categorized by the Socio-Demographic Index (SDI); expected values based on the SDI and disease rates in all locations are shown as the black line. Each point represents the observed age-standardised YLD rate for each country in 2021. YLD鈥�=鈥墆ears lived with disability (generated from data available at )

Discussion

The findings of our study highlight the significant public health challenge posed by BPH in the MENA region. In 2021, BPH accounted for approximately 4.7 million prevalent cases, with an age-standardised point prevalence of 2,168.6 per 100,000 population. The age-standardised incidence rate for BPH was recorded at 250.2 cases per 100,000, resulting in an estimated 604,200 new cases. These figures indicate a rising trend in the burden of BPH, aligning with global data that illustrate a substantial increase in the prevalence of this condition over the past few decades [32].

Globally, the prevalence of BPH increased from 5.48 million cases in 1990 to 11.26 million cases in 2019. This rise can be attributed to demographic shifts, particularly the ageing population, as well as lifestyle changes that influence the incidence of BPH [33]. In comparison, our study shows that the MENA region, with its unique socio-economic dynamics and healthcare systems, exhibits a comparable burden of disease. The prevalence and incidence rates found in our research are consistent with findings from North America and Europe, which report similar Figs.听[34, 35].

The regional variations in BPH prevalence within the MENA area are noteworthy. Countries such as Jordan, Qatar, and Iran exhibited the highest prevalence rates, which may reflect their advanced healthcare systems that facilitate better diagnosis and treatment of BPH. The high point prevalence in these nations suggests an urgent need for targeted healthcare strategies to manage the condition effectively [32]. In contrast, countries like Egypt and Yemen reported lower prevalence rates. This discrepancy may be indicative of several factors, including limited healthcare access, lower awareness of BPH, and cultural attitudes towards seeking medical care for urological issues. Cultural perceptions often influence the likelihood of seeking treatment for lower urinary tract symptoms (LUTS), potentially leading to under diagnosis of BPH in certain populations [36].

Numerous risk factors have been identified as contributing to the development of BPH. These include age, obesity, metabolic syndrome, diabetes, and lifestyle choices such as diet and physical activity. Age is the most significant risk factor, with the likelihood of developing BPH increasing markedly after the age of 50. Studies indicate that nearly 50% of men aged 60 and older will experience some degree of BPH symptoms [37].

Obesity and metabolic syndrome are also important risk factors. Research has demonstrated that increased body mass index (BMI) is linked to a higher incidence of BPH, as excess adipose tissue may lead to increased levels of oestrogen, which can stimulate prostatic growth [9]. Diabetes has also been linked to BPH, possibly due to its effects on hormonal balance and inflammatory processes that can affect the prostate [38].

Furthermore, lifestyle factors such as diet and physical inactivity may contribute to the development of BPH. Diets high in fat and low in fruits and vegetables have been suggested to increase the risk of BPH, while regular physical activity may have a protective effect [33]. However, the burden of BPH due to these risk factors is not adequately reported in the GBD 2021 study, primarily due to limited evidence on the specific contributions of these risk factors to BPH prevalence and outcomes. There is an urgent need for more comprehensive epidemiological studies to clarify the connections between these risk factors and BPH, which will enhance understanding and inform more effective management strategies.

Our analysis revealed significant increases in the age-standardised point prevalence, incidence, and YLDs linked with BPH across the region since 1990. This aligns with findings from global studies, indicating that the prevalence of BPH has escalated over the same period, driven primarily by an ageing population and changing lifestyle factors [39]. The rise in BPH prevalence can be due to several factors, such as demographic changes including increased life expectancy and urbanisation. As populations age, the incidence of age-related diseases like BPH also rises. Our findings suggest that effective management strategies, such as lifestyle modifications, medications, and various surgical interventions, are essential to alleviate the burden of BPH, particularly in ageing populations [9]. Moreover, to alleviate the increasing burden of BPH, it is essential to establish a comprehensive strategy that incorporates awareness initiatives, early detection programmes, and thorough management protocols. Public health efforts should aim to educate both the general populace and healthcare practitioners about the risk factors, symptoms, and treatment alternatives for BPH. Furthermore, integrating BPH management into primary healthcare frameworks can ensure that routine health practices include screening for BPH, particularly among high-risk groups such as the elderly and individuals with metabolic risk factors like obesity and diabetes.

The age patterns identified in our research reveal a steady rise in the prevalence, incidence, and age-standardised YLD rates for BPH with advancing age, peaking in the 65鈥�69 age group before declining in older populations. This aligns with previous research indicating that the risk of developing BPH increases significantly with age [37]. The peak age-standardised rates observed in the 65鈥�69 age group suggest that this demographic warrants targeted screening and intervention strategies to manage BPH effectively. Interestingly, while the overall trend indicates increasing prevalence, the decline observed in older age groups (beyond 75 years) may warrant further investigation. It is possible that the mortality rates associated with comorbid conditions in older adults could impact the prevalence rates reported. Furthermore, the declining incidence in these age groups may also indicate a need for improved access to healthcare and awareness campaigns to encourage diagnosis and treatment among older adults. Our findings regarding age-specific YLD rates further emphasise the increasing burden of BPH among older populations. The steady increase in YLD counts with age illustrates the condition鈥檚 growing impact on quality of life, necessitating robust healthcare responses to address the needs of these individuals [38].

One intriguing aspect of our analysis was the positive correlation between YLD rates and the SDI in the MENA region. This correlation suggests that areas with higher socio-economic development experience a greater burden of BPH. Countries such as Jordan and Qatar, which have higher SDIs, demonstrate a higher-than-expected burden of BPH, likely due to better healthcare access leading to increased diagnosis and reporting rates. In contrast, countries like Oman and Turkey exhibited lower-than-expected burdens, suggesting that different healthcare delivery models or cultural attitudes towards healthcare-seeking behaviours may be at play. A higher reporting rate of BPH cases in high SDI countries is supported by greater access to healthcare resources, such as routine check-ups and efficient diagnostic tools commonly available in these countries. Additionally, the prevalence of BPH is significantly influenced by socioeconomic factors, including higher income and educational levels, as well as increased healthcare insurance coverage [40]. The documented prevalence may also be attributed to a stronger culture of health awareness and preventive care in these areas. Nevertheless, discrepancies remain, as evidenced by racial disparities. Despite having a higher socioeconomic status, some groups report lower BPH diagnoses, potentially due to healthcare access inequalities and cultural influences [40]. This suggests that the complexity of BPH extends beyond economic status. Understanding these socio-economic dynamics can help inform public health interventions aimed at reducing the burden of BPH in the region. This aligns with previous research indicating that socio-economic factors significantly influence the management of BPH [41].

The findings of our study highlight the need for public health strategies tailored to the unique characteristics of the MENA region. As the prevalence of BPH continues to rise, particularly among ageing populations, there is a pressing need for enhanced screening and treatment options to mitigate the impact of this condition. Public health initiatives should focus on raising awareness of BPH and its symptoms, particularly among older adults. Educational campaigns that target both healthcare providers and the public can play a crucial role in promoting the early detection and treatment of BPH. Additionally, policymakers should consider implementing guidelines for the management of BPH that take into account the specific socio-economic and cultural contexts of the MENA region [9]. Moreover, healthcare systems in the region must adapt to the growing burden of BPH by allocating resources for the training of healthcare professionals in the diagnosis and treatment of this condition. Investment in research is also crucial to further understand the socio-economic determinants of BPH and develop effective interventions to address the needs of affected populations.

Strengths and limitations

Although this research offers important insights, it is important to acknowledge several limitations. Firstly, the differences in terminology between Benign Prostatic Obstruction (BPO) and BPH must be addressed. BPH refers to the benign enlargement of prostate tissue, whereas BPO describes the clinical condition resulting in urinary obstruction, which is more applicable in practice [42]. This difference is significant because histological BPH may not always present symptoms, affecting diagnosis and reporting. The reliance on ICD-10 codes (N40 series), which do not differentiate between BPH and BPO, impedes data interpretation and comparability. This limitation may lead to inaccurate prevalence estimates. Future studies should incorporate these distinctions into their methodologies and interpretations to enhance the precision and applicability of findings in prostate health research.

Secondly, we used retrospective data, which can introduce biases, such as selection and recall bias, arising from discrepancies in diagnostic criteria and data collection practices across various regions and time periods. These factors can affect the reliability and accuracy of the findings. This issue underscores the need for cautious interpretation and highlights the importance of future studies aiming for more comprehensive and prospective data collection methods.

Thirdly, this study relies on reported data, which may be subject to biases from underreporting or misdiagnosis of BPH, particularly in lower-resource settings. Cultural perceptions of urological diseases can influence the likelihood of seeking medical attention, potentially leading to discrepancies in prevalence Figures [43]. Intra-regional healthcare disparities within the MENA region stem from this limitation, potentially leading to inaccuracies in the estimated prevalence of BPH. This oversight may result in overestimates or underestimates of BPH prevalence due to unequal access to and quality of healthcare across different countries. Regions with better healthcare infrastructure may report higher diagnosis rates, inflating prevalence estimates, whereas areas with limited resources may exhibit artificially low rates [44, 45].

Furthermore, while we identified correlations between SDI and the burden of BPH, causation cannot be established from our analysis. Additional research is needed to examine the underlying factors contributing to these relationships. Moreover, while we examined trends over time, the complexity of BPH management and the interplay of lifestyle factors, such as diet and physical activity, were not thoroughly investigated, and these may have a significant impact on the disease's trajectory.

Future research should focus on longitudinal studies that explore the impact of socio-economic factors on the prevalence and management of BPH. Investigating how cultural attitudes towards healthcare influence diagnosis and treatment-seeking behaviour will also be beneficial. Additionally, the role of lifestyle factors, such as obesity and physical inactivity, should be examined in greater depth, as these have been linked to the development of BPH in various populations. Furthermore, to address healthcare disparities, future research should include and adjust听for factors related to healthcare access, quality of care, and local healthcare infrastructure. Moreover, comparative studies between high and low SDI countries within the MENA region can offer valuable insights into effective healthcare delivery models. Understanding the barriers to healthcare access in lower-resource settings can inform targeted interventions aimed at improving BPH management in these populations. Moreover, researchers can achieve a more accurate understanding of the true burden of BPH in different MENA countries by employing a more detailed methodology, such as segmenting data by healthcare system quality or differentiating between urban and rural settings. Finally, qualitative research into patient experiences with BPH can shed light on the psychosocial impacts of the condition and inform the development of patient-centred care approaches. Engaging patients in the research process will also enhance the relevance and applicability of findings to clinical practice.

Conclusion

Our study reports the substantial burden of BPH in the MENA region, emphasising the urgent need for tailored public health strategies to address its rising prevalence and associated disability. The correlation between socio-demographic factors and the BPH burden warrants further investigation to inform healthcare policies aimed at managing this common condition. As the ageing population continues to grow, it is important to develop effective management strategies to mitigate the impact of BPH on individuals and healthcare systems. The insights from this study can enhance the understanding and management of BPH, ultimately improving health outcomes in the MENA region.