Quarrier Scott, Li Shuang, Penniston Kristina L, Best Sara L, Hedican Sean P, Jhagroo Roy A, Nakada Stephen Y
Department of Urology, University of Wisconsin, Madison, WI.
Department of Urology, University of Wisconsin, Madison, WI.
Urology. 2020 Dec;146:67-71. doi: 10.1016/j.urology.2020.09.025. Epub 2020 Sep 28.
To determine if socioeconomic status (SES) correlates with severity of kidney stone disease and 24-hour urine parameters.
An IRB approved prospectively maintained database for nephrolithiasis was retrospectively analyzed for both 24-hour urine results and surgical procedures performed from 2009 to 2019. Severely distressed communities (SDC) were categorized as those with a Distressed Communities Index (DCI), a composite measure of SES, score in the top quartile (lowest for SES). Univariate and multivariate analyses were performed to evaluate the strength of the association of DCI on: stone size at presentation, need for and type of surgical procedure, need for staged surgery and specific stone risk factors in 24-hour urine collections.
Surgical procedures were performed on 3939 patients (1978 women) who were not from SDC and 200 (97 women) from SDC. Patients from SDC were older (57.1 years vs 54.2 years; P = .009). Patients from SDC were more likely to undergo proportionally more invasive procedures (17.5% vs 11.6%; P = .011) and require staged surgery at a higher rate (13.0% vs 8.5%; P = .028). Men from SDC had larger stones (12.5 mm vs 9.7 mm; P = .001). Among 24-hour urine results from 2454 patients (1187 women), DCI was not correlated with sodium, calcium, magnesium, volume, oxalate, phosphate, and pH levels. Higher DCI (lower SES) correlated with lower urine citrate (P = .001) and lower urine potassium (P = .002).
SES correlates with larger stone burden at the time of urologic intervention, requires proportionally more invasive procedures and more staged procedures. Lower SES correlated with lower urine citrate and potassium.
确定社会经济地位（SES）是否与肾结石疾病的严重程度及24小时尿液参数相关。
对一个经机构审查委员会（IRB）批准的、前瞻性维护的肾结石数据库进行回顾性分析，内容包括2009年至2019年的24小时尿液检测结果和所实施的外科手术。社会经济状况严重不佳的社区（SDC）被定义为那些社区困境指数（DCI，SES的综合衡量指标）得分处于最高四分位数（SES最低）的社区。进行单因素和多因素分析，以评估DCI与以下方面关联的强度：就诊时的结石大小、手术需求及类型、分期手术需求以及24小时尿液检测中的特定结石风险因素。
对3939例非SDC患者（1978例女性）和200例SDC患者（97例女性）实施了外科手术。SDC患者年龄更大（57.1岁对54.2岁；P = 0.009）。SDC患者更有可能接受比例上更多的侵入性手术（17.5%对11.6%；P = 0.011），且需要分期手术的比例更高（13.0%对8.5%；P = 0.028）。SDC男性患者的结石更大（12.5毫米对9.7毫米；P = 0.001）。在2454例患者（1187例女性）的24小时尿液检测结果中，DCI与钠、钙、镁、尿量、草酸盐、磷酸盐和pH水平无关。较高的DCI（较低的SES）与较低的尿枸橼酸盐（P = 0.001）和较低的尿钾（P = 0.002）相关。
SES与泌尿外科干预时更大的结石负荷相关，需要比例上更多的侵入性手术和更多的分期手术。较低的SES与较低的尿枸橼酸盐和尿钾相关。
