Reply to Editorial Comment: A Contemporary Analysis of the Prevalence and Incidence of Nephrolithiasis in the United States

Le résumé fourni par la source

The National Health and Nutrition Examination Survey (NHANES) is administered by the US Centers for Disease Control and Prevention and analyzed every couple of years to determine the prevalence of nephrolithiasis in the United States. An analysis by Scales et al1 of NHANES 2007 to 2010 identified that the prevalence of nephrolithiasis was 10.6%, or approximately 1 in 11 American individuals. This study identified that stones were most prevalent in White American individuals at 10.3%, followed by Hispanic at 6.4% and Black individuals at 4.3%. The prevalence of stones for men was 10.6% vs 7.1% for women. Thus, female sex was also associated with a reduced odds ratio (OR) of stones (OR 0.63, P < .001). An updated analysis of NHANES 2015 to 2018 by Hill et al2 identified that the prevalence of stones in the United States had increased to 11.0% and the 12-month incidence was 2.1%. The authors did not report the absolute prevalence of stones by race, but did identify that White American individuals still had the highest prevalence of nephrolithiasis compared with Black (relative risk [RR] 0.52, P < .001), Hispanic (RR 0.76, P = .002), and Asian individuals (RR 0.51, P < .001) on multivariable regression. Interestingly, in a stark contrast to Scales et al analysis, the other/multiracial group had a higher prevalence (RR 1.06, P = .8) and incidence of stones (RR 1.16, P = .58) compared with White individuals, but this was not statistically significant. Female sex still had a lower relative risk of stones (RR 0.83, P < .001) compared with men, but the magnitude of the difference was narrowing. The narrowing sex disparity is thought to be driven by an increase in nephrolithiasis incidence for women and a decrease for men.3 Our study had several novel insights.4 First, the prevalence and incidence of nephrolithiasis in the United States have plateaued at 9.8% and 1.8%. Whether this is a temporary finding or whether the NHANES sample in 2015 to 2018 overestimated the prevalence of stones, remain to be seen. Second, although the prevalence of stones for men is higher at 11.0% than 8.8% for women, the difference is no longer statistically significant (P = .18), which is the first time this has been noted in NHANES. This is likely driven by an increase in incidence for women compared with men (4.1% vs 3.0%) in the 30 to 39 year group. Next, the racial differences in stone prevalence and incidence continues shift. In our study, the other/multiracial group had the highest prevalence at 13.9%, followed by White individuals at 11.0%, Hispanic individuals at 10.4%, Mexican American individuals at 7.5%, Black individuals at 5.8%, and Asian individuals at 5.3%. On multivariable regression, the increase in stone prevalence (OR 1.33, P = .13) and incidence (OR 2.00, P = .09) for the other/multiracial group were still not statistically significant, similar to the Hill et al analysis. However, the magnitude of the difference in prevalence and incidence for the other/multiracial group continue to increase and may become significant on the next NHANES analysis. Unfortunately, the racial categories for NHANES are generic, and no further detail can be ascertained. Finally, as Sepulveda et al.5 have noted, the finding that the 30 to 39 year group had the highest incidence of stones with an OR of 4.85 (P < .0001) on multivariable analysis. Further research on the factors driving these changes and a renewed focus on equitable access to metabolic evaluation and dietary counseling is needed because these individuals could have recurrent episodes of stones and increasing health care utilization. DISCLOSURES Dr Matthew S. Lee is a consultant for Boston Scientific and Richard Wolf Corporation and on the Data Monitoring Committee for Butterfly. He was supported by the Ohio State University College of Medicine Research Innovation Career Development Award. Dr Bodo Knudsen is a consultant for Olympus.

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