Soucie J M, Coates R J, McClellan W, Austin H, Thun M
Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA.
Am J Epidemiol. 1996 Mar 1;143(5):487-95. doi: 10.1093/oxfordjournals.aje.a008769.
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 > or = 30 years, recruited nationally in 1982. Information on risk factors for stones including age, race, education, body mass, hypertension, and diuretic and vitamin C supplement use was obtained by self administered 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.
为了确定美国肾结石发病率的地域差异是否归因于个人和环境暴露的不同，作者研究了横断面数据，这些数据包含从1982年全国招募的1,167,009名年龄≥30岁的男性和女性中收集的关于自我报告的、医生诊断的肾结石信息。通过自我填写问卷获取了包括年龄、种族、教育程度、体重、高血压以及利尿剂和维生素C补充剂使用情况等结石危险因素的信息。牛奶、咖啡、茶、软饮料和酒精的摄入量基于食物频率数据。根据居住州为受试者分配环境温度和阳光水平指数。男性和女性中，东南部的结石患病率几乎是西北部的两倍。在控制了其他结石危险因素后，环境温度和阳光指数与结石患病率独立相关。在对温度、阳光和饮料摄入量进行调整后，男性的区域差异消除，女性的区域差异大幅减少。其他因素似乎对区域差异没有影响。这些结果表明，环境温度和阳光水平是结石的重要危险因素，温度、阳光和饮料暴露的差异可能导致地域差异。
