title: The effect of climate variability on urinary stone attacks: increased incidence associated with temperature over 18 °C: a population-based study.
abstract: The aim of this study was to evaluate the effect of seasonal variation and climate parameters on urinary tract stone attack and investigate whether stone attack is increased sharply at a specific point. Nationwide data of total urinary tract stone attack numbers per month between January 2006 and December 2010 were obtained from the Korean Health Insurance Review and Assessment Service. The effects of climatic factors on monthly urinary stone attack were assessed using auto-regressive integrated moving average (ARIMA) regression method. A total of 1,702,913 stone attack cases were identified. Mean monthly and monthly average daily urinary stone attack cases were 28,382 ± 2,760 and 933 ± 85, respectively. The stone attack showed seasonal trends of sharp incline in June, a peak plateau from July to September, and a sharp decline after September. The correlation analysis showed that ambient temperature (r = 0.557, p < 0.001) and relative humidity (r = 0.513, p < 0.001) were significantly associated with urinary stone attack cases. However, after adjustment for trends and seasonality, ambient temperature was the only climate factor associated with the stone attack cases in ARIMA regression test (p = 0.04). Threshold temperature was estimated as 18.4 °C. Risk of urinary stone attack significantly increases 1.71% (1.02-2.41 %, 95% confidence intervals) with a 1 °C increase of ambient temperature above the threshold point. In conclusion, monthly urinary stone attack cases were changed according to seasonal variation. Among the climates variables, only temperature had consistent association with stone attack and when the temperature is over 18.4 °C, urinary stone attack would be increased sharply.
authors.affiliation: Department of Urology, Konkuk University School of Medicine, 120-1, Neung-Dong-Ro, Gwangjin-Ku, Seoul  143-729, Korea, 20110075@kuh.ac.kr.
authors.forename: Hyoung Keun
authors.initials: HK
authors.lastname: Park
authors.forename: Sang Rak
authors.initials: SR
authors.lastname: Bae
authors.forename: Satbyul E
authors.initials: SE
authors.lastname: Kim
authors.forename: Woo Suk
authors.initials: WS
authors.lastname: Choi
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: Paick
authors.forename: Kim
authors.initials: K
authors.lastname: Ho
authors.forename: Hyeong Gon
authors.initials: HG
authors.lastname: Kim
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Lho
mesh_terms: D002980:Climate; D006801:Humans; D015994:Incidence; D012621:Seasons; D013696:Temperature; D014545:Urinary Calculi / Q000453:epidemiology*