Kidney stones in black women in the United States: Data from the Black Women's Health Study
Maria J. D'Amico, BA1, Shaun Wason, MD2, Lynn Rosenberg, ScD3, Yvette Cozier, DSc3
1Boston University School of Medicine, Boston, MA, 2Boston Medical Center, Boston, MA, 3Boston University School of Public Health, Boston, MA
Nephrolithiasis is a common urologic condition and a significant source of patient morbidity and healthcare expenditure. There has been an increase in the prevalence of kidney stones in the United States in recent years, especially among black and female patients. There are few epidemiologic studies of kidney stones focusing on black women. We present data on the prevalence, clinical characteristics, and diagnostic work up of women with self-reported kidney stones among participants in the Black Women’s Health Study (BWHS).
The BWHS, initiated in 1995, is a prospective, epidemiologic study of 59,000 US black women (age 21-69) followed via biennial postal and web questionnaires. The 2005 questionnaire asked whether participants had ever been diagnosed with kidney stones as well as data on patient characteristics (age, education, geographic region), health behavior, medical factors (body mass index, type-2 diabetes, hypertension, high cholesterol, gallstones), and use of medical care. In 2017, a subset of BWHS participants (n=2,570) completed a web-based questionnaire focusing on urinary tract health (e.g., urinary incontinence, UTI), including questions regarding undergoing metabolic work-up, imaging, and surgical procedures related to the diagnosis of kidney stones. Chi-square tests were used to compare characteristics between participants with and without a history of nephrolithiasis.
Among the 43,179 participants who completed the 2005 survey, 836 (2%) reported ever being diagnosed with kidney stones. Women with and without a history of kidney stones were similar in terms of geographic location, education level, and health insurance coverage. Respondents with a history of kidney stones were more likely to be older (P<0.0001), to have smoked (P=0.04), to be obese (P=0.01), and to have been diagnosed with a comorbid condition (type-2 diabetes (P<0.0001), hypertension (P=0.01), hyperlipidemia (P<0.0001), gallstones (P<0.0001). The 2,570 sub-study participants in 2017 were slightly heavier, more educated, and more likely to reside in the Northeast than BWHS participants overall. Eight percent reported a history of kidney stones of which 40% experienced ≥2 stones in their lifetime, 32% completed a metabolic work up, 70% had undergone a CT scan, and 29% had undergone a surgical procedure.
BWHS participants who reported a history of kidney stones were more likely to have other medical comorbidities, including key components of metabolic syndrome and gallstones. These data are consistent with hypotheses relating lifestyle-associated risk factors with nephrolithiasis and also confirm reports of lower rates of metabolic evaluation among African American patients despite respondents’ multiple risk factors for kidney stones. Further study is needed to establish the temporal sequence between nephrolithiasis and common comorbid conditions, including gallstones and diabetes, as well as to identify the barriers and facilitators of diagnostic work up of kidney stones in black women.
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