長期暴露於細懸浮微粒與以濕球黑球溫度評估之熱壓力對腎結石疾病風險的影響：一項在台灣的縱向世代研究
梁美家^1、2、李季穎、耿俊閎
1 高雄市立小港醫院泌尿部; 2 高雄醫學大學附設中和紀念醫院泌尿部

Long-Term Exposure to Fine Particulate Matter and Heat Stress Measured by Wet-Bulb Globe Temperature and the Risk of Kidney Stone Disease: A Longitudinal Cohort Study in Taiwan
Mei-Kar Leong^1、2、Chi-Ying Lee²、Jiun-Hung Geng¹.
1 Department of Urology, Kaohsiung Siaogang Hospital, Kaohsiung, Taiwan;
2 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Background: Kidney stone disease (KSD) is a growing global health concern with increasing incidence and recurrence, yet evidence regarding environmental determinants, particularly long-term air pollution and heat exposure, remains scarce. While both fine particulate matter (PM₂.₅) and elevated ambient temperature have been independently linked to renal outcomes, their combined effect on KSD risk has not been well established.

Methods: We conducted a longitudinal cohort study of 20,670 adults from the Taiwan Biobank with a mean follow-up of 43 months. Long-term exposures to PM₂.₅ and wet-bulb globe temperature (WBGT) were estimated using advanced geospatial artificial intelligence (Geo-AI) models at high spatial and temporal resolution. Cox proportional hazards models were applied to evaluate associations between PM₂.₅, WBGT, and incident KSD, with adjustment for demographic, lifestyle, clinical, and biochemical covariates. Interaction terms were included to assess potential synergistic effects between PM₂.₅ and WBGT.

Results: During follow-up, 511 incident KSD cases were identified (2.5%). Higher PM₂.₅ exposure was associated with a significantly elevated risk, with participants in the highest quartile having an 84% greater risk compared with the lowest quartile (HR 1.841, 95% CI 1.429–2.372, p<0.001). Similarly, elevated WBGT was independently associated with KSD risk, with the high WBGT group (26–27°C) demonstrating a 59% increase compared with the low group (16–25°C) (HR 1.593, 95% CI 1.335–1.900, p<0.001). Importantly, interaction analyses revealed synergistic effects: participants in the lowest quartile of PM₂.₅ exposure under high WBGT had more than a twofold higher risk compared with their low-WBGT counterparts (HR 2.179, 95% CI 1.350–3.519, p=0.001).

Conclusions: This study provides the first longitudinal evidence from Asia demonstrating that long-term exposure to both PM₂.₅ and heat stress, as measured by WBGT, independently and synergistically increases the risk of incident KSD. These findings highlight the need for integrated public health strategies that address both air quality and climate change in the prevention of kidney stone disease.