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Ambient nitrogen dioxide and composition-specific risk of urolithiasis: a multicenter time-stratified case-crossover study
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DOI：10.1186/s12889-026-28561-0.png)
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Abstract
En 中文
Emerging evidence suggests that ambient air pollution and meteorological variation may trigger urolithiasis, but stone-composition–specific and lagged associations are poorly characterized. We conducted a multicenter, time-stratified case-crossover study in Guangzhou (training set) with 25,374 laboratory-confirmed urinary stones and two independent validation cohorts from Tianjin (n = 99,552) and Guizhou (n = 3,021). Six criteria pollutants (PM₂.₅, PM₁₀, NO₂, SO₂, CO, O₃_8h) and meteorological factors (temperature, precipitation, wind speed) were linked to case and referent days. Conditional logistic regression and generalized additive models quantified short-term (lag 0–7, moving averages) and long-term (6-month and 1-year) effects overall and for seven stone compositions, with stratified analyses by age, calendar period, season, and co-pollutant strata. In Guangzhou, NO₂ was consistently and positively associated with urolithiasis risk across single-pollutant, multi-pollutant, and GAM models. Short-term NO₂ exposure showed the strongest effects at lag 0 and lag 2–4, particularly for carbonate apatite and calcium oxalate stones, and 1-year averages of NO₂ were positively associated with uric acid stones. Higher temperature was generally protective, whereas PM₁₀ displayed mainly inverse or U-shaped associations with overall and composition-specific risk. The NO₂–urolithiasis association was robustly replicated in Tianjin and Guizhou, and key composition-specific patterns (NO₂–calcium oxalate, PM₁₀–carbonate apatite) were confirmed in the Guizhou cohort. Stratified analyses indicated greater susceptibility among young adults (18–65 years), in autumn, on both weekdays and weekends, and under specific co-pollutant and meteorological conditions, while results were stable across pre- and post-2019 periods. Ambient NO₂ is a consistent and composition-dependent risk factor for urolithiasis, whereas PM₁₀ and meteorological factors show more complex, often non-linear relationships. Integrating air quality management and heat-health strategies into kidney stone prevention may be particularly important in highly polluted, climatically vulnerable regions.
Keywords:
Air pollution
Meteorological factors
Urolithiasis
Environmental health
Lag effects
Stone compositions
Case-crossover study
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3.6
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3.2W
Citations:
8.5W
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Cited Papers