Relation between Geographic Variability in Kidney Stones Prevalence and Risk Factors for Stones
American Journal of Epidemiology
To determine whether geographic variability in rates of kidney stones in the United States was attributable to differences in personal and environmental exposures, the authors examined cross-sectional data that included information on self-reported, physician-diagnosed kidney stones collected from 1,167,009 men and women, aged a30 years, recruited nationally in 1982. Information on risk factors for stones including age, race, education, body mass, hypertension, and diuretic and vitamin C
... nd vitamin C supplement use was obtained by selfadministered questionnaire. Consumption of milk, coffee, tea, soft drinks, and alcohol was based on food frequency data. Indices of ambient temperature and sunlight level were assigned to subjects based on state of residence. Stones were nearly twice as prevalent in the Southeast as in the Northwest among men and women. Ambient temperature and sunlight indices were independently associated with stones prevalence after controlling for other risk factors for stones. Regional variation was eliminated for men and greatly reduced for women after adjustment for temperature, sunlight, and beverage consumption. Other factors appeared to not contribute to regional variation. These results provide evidence that ambient temperature and sunlight levels are important risk factors for stones and that differences in exposure to temperature and sunlight and beverages may contribute to geographic variability. Am J Epidemiol 1996; 143:487-95. geography; kidney calculi; risk factors; urolithiasis * Mean annual temperature of the major weather reporting dty in each state. If more than one city was listed, the average of the temperatures reported for those cities was used. t Sunlight index for each state Is a computed value based on ultraviolet radiation levels over a range of latitudes and annual doud cover measurements.