空氣污染物與尿路結石風險之間的關聯

朱芷君、劉展榮

國立成功大學醫學院附設醫院 泌尿部

Associations between air pollutants and the risk of urolithiasis

Zhi-Jun Zhu、Chan-Jung Liu

Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan

Purpose: Air pollutants, including particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO2), and ozone (O3) have harmful effects on health. Recent evidence have indicated air pollution may exacerbate the risk of urolithiasis. This study is aimed to identify the association of air pollutants with incident and recurrent risks of urolithiasis.

Materials and Methods: This retrospective case-control study was approval by institutional review boards: A-ER-112-191. We identified all urolithiasis patients from 2016 to 2020 based on National Health Insurance Research Database. Incident urolithiasis was defined as the absence of a prior disease code (ICD-9: 592.0-592,9; ICD-10: N20.0-N20.9). When a patient experienced a relapse and had one ICD code after the index date, it was considered recurrence. The control was selected without urolithiasis diagnosis and was 10-fold frequency matched according to sex. We utilized a geospatial-artificial intelligence-based ensemble mixed spatial model to estimate long-term air pollutants concentrations. Conditional logistic regressions with adjustments for comorbidities were applied.

Results: We observed a significant decreasing trend in PM2.5, CO, and NO2, with the exception of an increase in O3 during the observed years. We found that significant seasonality in PM2.5, CO, and NO2 variations, that was, the highest levels were observed in winter and the lowest levels were in summer. The data for O3 showed a slight increasing trend from 33.85 ppb to 36.59 ppb. The concentration of O3 varied seasonally, with higher levels in spring and fall, and lower levels in summer and winter.

During follow-up, 157,866 urolithiasis cases were recorded, showing higher incidence in summer, and the mean incidence rates were 66.23 and 37.86 per 100,000 person-years for male and female, respectively.

Examining the relationship between air pollutants, there has consistently been a linear positive correlation between PM2.5, NO2, and CO during the follow-up duration. However, O3 had a negative correlation with these three air pollutants. The incidence of urolithiasis was negatively correlated with PM2.5, NO2, and CO (Figure). The incidence of urolithiasis was positively correlated with O3 from 2016 to 2019. Interestingly, the incidence of recurrent urolithiasis was still negatively correlated with PM2.5, NO2, and CO during the follow-up duration.

Conclusions: Ambient air pollutants may influence the incidence and recurrent risks of urolithiasis.