BACKGROUND: Pediatric stone disease incidence has increased steadily over the last few decades. Several interrelated factors have been proposed to contribute to these epidemiologic trends including increased ambient temperature, body habitus, and food insecurity. Given the significant cohort of children living with food insecurity in the United States, the aim of this study is to explore the relationship between food desert residence and surgical intervention for stone disease in a cohort of pediatric patients.
METHODS: Records of pediatric patients who presented to a single tertiary pediatric medical center for nephrolithiasis between 2009 to 2023 were retrospectively reviewed. Patients were included in the study if they had an obstructing stone; were older than 5 years of age; lacked anatomical predispositions to stone formation; and were regularly consuming a solid diet. Variables studied included demographics, BMI, medical comorbidities and family history, procedures performed, and stone burden. Patients’ likelihood of living in a food desert was approximated using the United States Department of Agriculture Food Access Research Atlas.
RESULTS: Of 637 patients reviewed, 199 pediatric patients (90 male and 109 female) were included in our analysis. One hundred and thirty-two patients (69.1%) had undergone ureteroscopy. Fifty-seven patients (28.6%) had a documented psychiatric comorbidity at time of presentation, with ADHD being the most common psychiatric comorbidity treated via medical management (n=27, 47.4%). Our analysis demonstrated a significant association between surgical intervention and medical history of UTI (p=0.038), food desert residence (p=0.002), and increased stone size (p<0.001). Additionally, increased time between discharge on medical expulsive therapy and surgery decision was associated with past medical history of stones (p=0.015), food desert residence (p=0.047), and psychiatric comorbidity (p=0.050).
CONCLUSIONS: In this study, we found a significant association between food desert residence and surgical intervention for pediatric nephrolithiasis. We also discuss a potential new association with pediatric stone disease: psychiatric comorbidity and the medical management of such diagnoses. To our knowledge, our study is among the first to assess the association between food insecurity and surgical intervention of pediatric nephrolithiasis. Given the importance diet plays in medical management of stone development, clinicians should take care to assess food security status of pediatric nephrolithiasis patients. Limitations to our study include a patient cohort from a singular hospital system, small sample size, and the changing nature of a patients’ food security status.s