Abstract

STUDY OBJECTIVE--To provide a systematic overview of worldwide trends in mortality from benign prostatic hyperplasia (BPH) over the past four decades. DESIGN--This was a descriptive analysis based on age adjusted mortality rates for BPH between 1950 and 1992 for 41 countries from five continents. SETTING--Official death certifications from the World Health Organization database. MAIN RESULTS--In the 1950s, the highest age adjusted (on the world standard population) mortality rates for BPH in Europe were in Denmark (22.8/100,000) and Germany (18.1), followed by Scandinavian countries, the UK, and Switzerland. Italy had rates around 10/100,000, and rates were lower in eastern and southern Europe (5-8/100,000). Between 1950 and 1990, a fall of over 90%, or even 95%, was observed in most western European countries. Thus, in the early 1980s, overall mortality from BPH ranged between 0.5 and 1.5/100,000 in most western European countries. In proportional terms, similar reductions were registered in other developed countries of North America, Asia (that is, Japan or Singapore), and Oceania. A fall in rates was also observed in eastern Europe and in Latin America, particularly from the late 1970s onwards, although these reductions were generally much smaller. Thus, in the early 1990s, most countries in these areas had BPH rates between 1 and 5/100,000. The pattern of trends was, at least qualitatively, similar at younger ages, although most falls were proportionally greater. CONCLUSIONS--The most probable interpretation of these trends is that therapeutic improvements--including more widespread and timely surgery, introduction of less invasive techniques, such as transurethral prostatectomy, and possibly the development of medical treatments--have had a favourable and substantial impact on BPH mortality. There are, however, areas of the world, including several countries of western Europe and South America, where rates are still very high.