Stone Composition Variation in a Diverse Urban Population: Investigating the Influence of Ethnicity and Socioeconomic Deprivation on Stone Type

Abstract

Aim: The aim of this study is to investigate whether stone composition is influenced by genetic factors, represented by ethnicity, or environmental factors represented by socioeconomic deprivation. By analysing a large cohort of stone formers in an ethnically diverse urban population in East London UK, we aim to identify trends among our stone patients and ask what causes specific stones - genetic or environmental? Method: A retrospective analysis of patients undergoing stone interventions in 2018, 2019, 2022 was performed at multi-hospital NHS Trust in East London. Patient electronic records were reviewed for stone composition and postcodes, which was compared against the English index of deprivation data (2019). Multinominal logistical regression analysis was performed to observe for statistically significant association between stone type, index of multiple deprivation decile (IMDD) and ethnicity. Result(s): A total of 1086 patients in 2018, 2019, and 2022 were reviewed, and 716 were identified with stone analysis results. The most common stone types are calcium oxalate (67.6%). Ethnicity had 1.6x more impact on determining overall stone type compared to IMDD. Particularly, ethnicity had 2.4x, and 1.7x more influence on cystine and struvite stones respectively. IMDD had 2.6x and 2.1x more influence on uric acid stones and calcium oxalate respectively. Conclusion(s): Ethnicity and IMDD have influence on specific stone types. This is consistent with existing knowledge on certain stones with established genetic link like cystine stones. Interestingly uric acid and calcium oxalate stones appear to have more environmental influence which may be contributed by possible dietary differences among different IMDD.