Trends of Urolithiasis in China: A National Study Based on Hospitalized Patients from 2013 to 2018

Qin Wang; Yu Wang; Chao Yang; Jinwei Wang; Ying Shi; Haibo Wang; Luxia Zhang; Ming-Hui Zhao

doi:10.1159/000527967

Trends of Urolithiasis in China: A National Study Based on Hospitalized Patients from 2013 to 2018

Kidney Dis (Basel). 2022 Nov 7;9(1):49-57. doi: 10.1159/000527967. eCollection 2023 Jan.

Authors

Qin Wang^{1

2

3}, Yu Wang^{1

3}, Chao Yang^{1

3

4}, Jinwei Wang^{1

3}, Ying Shi⁵, Haibo Wang^{6

7}, Luxia Zhang^{1

3

4

7}, Ming-Hui Zhao^{1

3

8}

Affiliations

¹ Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China.
² Department of Nephrology, Xiangya Hospital Central South University, Changsha, China.
³ Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.
⁴ Advanced Institute of Information Technology, Peking University, Hangzhou, China.
⁵ China Standard Medical Information Research Center, Shenzhen, China.
⁶ Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
⁷ National Institute of Health Data Science at Peking University, Beijing, China.
⁸ Peking-Tsinghua Center for Life Sciences, Beijing, China.

Abstract

Introduction: The aim of this study was to explore the chronological trends in clinical features and utilization of healthcare resources for hospitalized patients with urolithiasis in China.

Methods: Patients with urolithiasis were extracted from the Hospital Quality Monitoring System, a national database of hospitalized patients in China, based on the International Classification of Diseases, Tenth Revision, codes. Variables including demographic characteristics, comorbidities, treatment modalities for urolithiasis, length of hospital stay, and expenditures were collected and analyzed.

Results: Among 79.8 million hospitalized patients, 3.5 million were diagnosed with urolithiasis with an increasing trend (from 3.0% in 2013 to 4.0% in 2018). Most of these patients had upper urinary tract calculi (76.6% in 2013 and 81.7% in 2018). Middle-aged patients (46-65 years) constituted the largest proportion with a stable trend (from 46.9% in 2013 to 48.8% in 2018), while the proportion of older patients (>65 years) showed an increasing trend (from 23.7% in 2013 to 27.4% in 2018). The percentages of gout/hyperuricemia, hypertension, diabetes, and cardiovascular disease among the hospitalized patients with urolithiasis increased steadily, with the sharpest increases in patients from rural areas. Overall, 656,952 patients (18.9%) received surgical interventions for urolithiasis. The proportions of ureteroscopy and extracorporeal shockwave lithotripsy increased steadily during the 6-year study period, with simultaneous decreases in open surgery and percutaneous nephrolithotomy. The median length of hospital stay decreased from 10 days to 8 days. The cost of urolithiasis intervention accounted for 2.0% of the total hospitalization fee in 2013 and increased to 2.7% in 2018.

Conclusions: The analysis showed an increasing trend in the percentage of hospitalized patients with urolithiasis, accompanied by an increased percentage of the total hospitalization fee for urolithiasis intervention during the 6-year study period. Based on the increasing trends in the proportion of older patients (>65 years) and percentages of metabolic comorbidities among patients with urolithiasis, an increased burden of urolithiasis on the healthcare system in China is anticipated.

Keywords: Intervention; Metabolic disease; Treatment; Trends; Urinary tract calculi; Urolithiasis.

Grants and funding

This study was supported by grants from the National Natural Science Foundation of China (91846101, 82003529), Beijing Nova Programme Interdisciplinary Cooperation Project (Z191100001119008), National Key R&D Program of the Ministry of Science and Technology of China (2019YFC2005000), Peking University (BMU2018MX020, PKU2017LCX05), CAMS Innovation Fund for Medical Sciences (2019-I2M-5-046), PKU-Baidu Fund (2019BD017), and the China-World Health Organization Biennial Collaborative Projects 2018–2019 (2019/892000-0). The authors thank the Bureau of Medical Administration and Medical Service Supervision, National Health Commission of the People's Republic of China, and the World Health Organization for the support of this study.