Predicted Climate-Related Increase In The Prevalence And Cost Of Nephrolithiasis In The U.S.

Main Category: Urology / Nephrology
Article Date: 21 Jun 2008 - 4:00 PDT

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ORLANDO, FL (UroToday.com) - Stone disease in the United States has been shown to be more prevalent in the southern states due to the warmer climate.

Pearle and colleagues from Dallas, Texas report that an unanticipated consequence of global warming may be an increase in stone disease resulting in a rise in health care expenditures.

The authors reviewed the estimates of temperature increases based on intermediate-severity models of warming from the Intergovernmental Panel on Climate Change. They found a 1-2°C of warming by 2050 for much of the U.S. They then used the Veterans Affairs dataset on stone prevalence obtained from the Urologic Diseases in America Project and revealed a strong correlation between physician office visits for a diagnosis of urolithiasis and mean annual temperature in different geographic regions, with a 4.2% increase in stone risk per °C (linear model). In contrast, published data from the Second Annual Cancer Prevention Survey, for which the prevalence of stone disease stratified by geographic area was derived, showed a peaked distribution (non-linear model). The linear and non-linear temperature-dependence models of stone risk were applied to the estimated mean annual temperature to obtain predicted prevalence of stone disease in 2050. The associated cost increase was then estimated. Their results indicated that a fraction of the U.S. population living in high risk stone zones was predicted to grow from 40% in 2000 to 50% by 2050, leading to a climate-related increase of at least 1-2 million lifetime cases of nephrolithiasis, a nearly 30% increase in some climate divisions.

Nationwide, the cost increase associated with this rise in stone disease could approach $1 billion annually, a 10-20% increase over current expenditures. The linear model of temperature-dependence predicted that increases in stone disease will be concentrated in warm high-population states including California, Texas, Florida and the Eastern Seaboard. The non-linear model predicted concentration in a mid-latitude band stretching from Kansas to Kentucky and Northern California.

The authors concluded that the impact of climate-related changes in stone disease will be non-uniformly distributed in the southern half of the country (linear model) or upper Midwest (non-linear model). Additionally, the increase in the number of stone interventions will result in a rise of stone-related health care costs of nearly $1 billion by 2050, a 25% increase over present-day costs estimates.

Presented by Margaret S Pearle, MD, Yair Lotan, MD, and Tom Brikowski, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Michael K. Louie, MD

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