BACKGROUND: Ureteral cancer is a rare cancer. This study aimed to provide an up-to-date and comprehensive analysis on the global trends of ureteral cancer incidence and its association with lifestyle and metabolic risk factors. METHODS: The incidence of ureteral cancer was estimated from the Cancer Incidence in Five Continents Plus and Global Cancer Observatory databases. We analyzed the (1) global incidence of ureteral cancer by region, country, sex, and age group by age-standardized rates (ASR); (2) associated risk factors on a population level by univariable linear regression with logarithm transformation; and (3) incidence trend of ureteral cancer by sex and age group in different countries by Average Annual Percentage Change (AAPC). RESULTS: The global age-standardized rate of ureteral cancer incidence in 2022 was 22.3 per 10,000,000 people. Regions with higher human development index (HDI), such as Europe, Northern America, and East Asia, were found to have a higher incidence of ureteral cancer. Higher HDI and gross domestic product (GDP) and a higher prevalence of smoking, alcohol drinking, physical inactivity, unhealthy dietary, obesity, hypertension, diabetes, and lipid disorder were associated with higher incidence of ureteral cancer. An overall increasing trend of ureteral cancer incidence was observed for the past decade, especially among the female population. CONCLUSIONS: Although ureteral cancer was relatively rare, the number of cases reported was rising over the world. The rising trends among females were more evident compared with the other subgroups, especially in European countries. Further studies could be conducted to examine the reasons behind these epidemiological changes and confirm the relationship with the risk factors identified.

Centre for Health Education and Health Promotion Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China

Department of Global Health and Development London School of Hygiene and Tropical Medicine London UK

Department of Global Health School of Public Health Peking University Beijing China

Department of Radiology and Nuclear Medicine Erasmus MC University Medical Center Rotterdam the Netherlands

Department of Surgery S H Ho Urology Centre The Chinese University of Hong Kong Hong Kong SAR China

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology La Croix du Sud Hôpital Quint Fonsegrives France

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology University of Texas Southwestern Dallas TX USA

Departments of Urology Weill Cornell Medical College New York NY USA

Division of Oncology Unit of Urology Urological Research Institute IRCCS Ospedale San Raffaele Milan Italy

Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

Division of Urology Department of Surgical Sciences AOU Città Della Salute E Della Scienza Di Torino Torino School of Medicine Turin Italy

European Association of Urology Young Academic Urologists Arnhem the Netherlands

Faculty of Public Health Mahidol University Bangkok Thailand

GRC 5 Predictive Onco Uro Sorbonne University AP HP Urology Pitie Salpetriere Hospital Paris France

Institute for Urology and Reproductive Health Sechenov University Moscow Russia

Jockey Club School of Public Health and Primary Care Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China

School of Public Health Fudan University Shanghai China

Suzhou Industrial Park Monash Research Institute of Science and Technology Suzhou China

The School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia

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