Urolithiasis in Tennessee: an occupational window into a regional problem

Am J Public Health. 1991 May;81(5):587-91. doi: 10.2105/ajph.81.5.587.


Background: Urinary tract stones (stones) are believed to be unusually common in the southeastern United States but neither the incidence of nor the risk factors for stones are known.

Methods: In three well-defined occupational populations in eastern Tennessee, we assessed the prevalence, incidence, and cumulative incidence of stones and measured biochemical risk factors for lithogenesis.

Results: The age-adjusted prevalence of stones was 18.5 percent in Tennessee compared to 7.7 percent among White males in US NHANES (prevalence ratio 2.4, 95% CI 1.7, 3.3). The cumulative incidence (risk) was 27.8 percent by age 65, higher than in any other reported population. Risk factors were age, a family history, and urinary saturation with calcium-oxalate (COAX). Persons with a positive family history and the highest measured CAOX index had a predicted lifetime risk of 88.8 percent. Biochemical factors affecting lithogenesis were hypercalciuria, hyperoxaluria, and low urine volume.

Conclusion: Future research should characterize the geographic boundaries of a southeastern "stone-belt" and explore genetic and dietary hypotheses that might explain it.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Calcium Oxalate / urine
  • Dairying
  • Humans
  • Incidence
  • Kidney Calculi / chemically induced
  • Kidney Calculi / epidemiology*
  • Kidney Calculi / urine
  • Logistic Models
  • Male
  • Metallurgy
  • Middle Aged
  • Occupations
  • Prevalence
  • Risk Factors
  • Tennessee / epidemiology
  • Uranium / adverse effects
  • Urine / chemistry


  • Calcium Oxalate
  • Uranium