Beyond Prevalence: Incidence Rates For Kidney Stones In The United States
Gina N. Tundo, MD1, William Meeks, MA2, Vernon Pais, MD1
1Dartmouth Hitchcock, Lebanon, NH, 2American Urological Association, Linthicum, MD
BACKGROUND: It is well documented that the prevalence of nephrolithiasis is increasing in adults in the United States over time. Approximately 11% of men and 7% of women have reported a lifetime history of nephrolithiasis in cross sectional studies. However, the burden of acute management may be better assessed from annual incidence rates. This accounting of new stone events, however, is not as well described or understood.
METHODS: The Medical Expenditure Panel Survey is a set of large-scale, healthcare utilization surveys of families, individuals, their healthcare providers, and employers, with surveys administered every 6 months for the duration of each individual's 2 year panel. We queried the survey data of adult participants between 2005 and 2015, with analysis conducted with provided weights and strata to allow our findings to be representative of the civilian non-institutionalized US adult population. Those with diagnosed renal or ureteral calculi as noted by ICD 9 codes were included as our incident stone formers.
RESULTS: In 2005, the mean age of stone formers was 45. 52.5% of stone formers were male, 91% white, and 47.6% were in the Southern US. The incidence of stone occurrences was 0.6% (177/33,961 individuals, weighted to represent population of 1,923,322/296,185,002 individuals). By 2015, the mean age was 51.7, with 52% male, 83% white, and 38.2% in the southern US. The overall incidence of stone occurrences increased to 0.9% (247/35,427 individuals, weighted to represent population of 2,810,497/321,423,251 individuals). This increase in incidence from 2005 to 2015 was statistically significant, with a p-value of <0.01.
CONCLUSIONS: In this large-scale, nationally-representative analysis of adults in the United States, the incidence of stone occurrence annually is less than 1%. Nonetheless, incidence rates do appear to be increasing over time, rising from 0.6% in 2005 to 0.9% in 2015. This data may help to better anticipate need for urologic care for stone disease and may help direct resource distribution.
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