Gender Equivalence in Prevalence of Nephrolithiasis Among Working and Reproductive-Aged U.S. Adults
Gina N. Tundo, MD1; Sari Khaleel, MD2; Vernon Pais, MD1
1Dartmouth Hitchcock, Lebanon, NH; 2University of Minnesota, Minneapolis, MN
Gender equivalence in prevalence of nephrolithiasis among working and reproductive-aged U.S. adults
BACKGROUND: Although urolithiasis affects both sexes, conventional teaching has proposed that men are up to 3x more likely to suffer from kidney stones. Clinical practice, however, refutes such disparity particularly among working-aged adults. Small studies have also suggested erosion of such a gender gap. As stone disease has been shown to increase work absenteeism, the significant financial burden this may impose warrants further evaluation of the epidemiology of stone disease in working and reproductive-aged adults. We therefore sought to examine the relationship between gender and stone prevalence among U.S. adults <50 years of age.
METHODS: We analyzed the nationally representative cohort of U.S. adults from the 2007-2012 National Health and Nutrition Examination Surveys. Weighted proportions and multivariate logistic regression of the cohort and pertinent subgroups were assessed to determine prevalence and odds of nephrolithiasis.
RESULTS: The complete NHANES cohort of 17,658 subjects -- weighted to represent the full nationwide U.S. population of 218,828,951 adults -- was 48.1% male and 51.9% female.
Focused upon our cohort of 8,888 adults weighted to represent 123,976,786 subjects (49.3% male and 50.7% female) less than 50 years old, there was no difference in stone prevalence (6.3% male and 6.4% female, respectively, p=0.85).
On unadjusted logistic regression of those under the age of 50, men were no more likely than women to report history of stones (OR 0.98, p=0.85). Multivariate logistic regression adjusting for diabetes, obesity, ethnicity, age, as well as water, sodium, and protein intake, confirmed there was no difference in stone prevalence between men and women (OR 1.1, p=0.51).
CONCLUSION: Among working and reproductive-aged U.S. adults less than 50 years of age, the much-touted gender disparity in stone prevalence is not present. Prior assessments of gender-based prevalence of stones may have failed to specifically assess this economically critical demographic, or there may in fact be a change in epidemiology. Recognition that women are equally as likely as men to form stones in this demographic suggests the need for continued efforts to better elucidate the pathophysiology of stones in women.
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