Advisor(s)
Cora Lewis
Committee Member(s)
Gregory Pavela
Suzanne Judd
School
School of Public Health
Document Type
Thesis
Department (new version)
Epidemiology
Date of Award
1-6-2025
Abstract
Kidney stone disease (KSD) is common, incurs high healthcare costs, and is associated with multiple chronic diseases and reduced quality of life. There is evidence that KSD risk is influenced by social determinants of health (SDOH). It has been estimated that half of KSD events could be prevented through dietary, lifestyle, and environmental risk factor modification. Individuals with adverse SDOH and those identifying as racial or ethnic minorities experience systemic barriers to adopting a healthier lifestyle and diet. We hypothesized that adverse SDOH are associated with higher KSD prevalence and that poor dietary quality explains a substantial proportion of this association. In this study, we tested this hypothesis using harmonized cross-sectional data on SDOH, dietary patterns, and KSD prevalence from 4 cohort studies with collective diversity in sex, race, and ethnicity: Coronary Artery Risk Development in Young Adults (CARDIA), Hispanic Community Health Study/Study of Latinos (HCHS/SOL), Multi-Ethnic Study of Atherosclerosis (MESA), and Strong Heart Family Study (SHFS). An SDOH count exposure variable was created based on annual household income, years of education, primary healthcare source, social support, and neighborhood poverty. Within individual cohorts, multivariable Poisson regression with robust variance estimation was performed to test the association between adverse SDOH and prevalent KSD, adjusting for relevant covariates as well as the Dietary Approaches to Stop Hypertension (DASH) score. Individual participant data were then pooled in a random effects meta-analysis. In total, there were 21,515 participants meeting study criteria, and the prevalence of KSD varied by cohort (range: 2.8% to 9.3%). In the meta-analyzed population, adverse SDOH were associated with lower KSD prevalence (PR 0.73, 95% CI: 0.56 to 0.94, for participants with 5 adverse SDOH vs. no adverse SDOH). Dietary pattern did not appear to mediate this association in any of the individual cohorts. Of the individual SDOH, only level of education ≤12 years was statistically significantly associated with prevalent KSD (PR 0.83, 95% CI: 0.74 to 0.92). We propose that access to healthcare, health literacy and lower self-reported asymptomatic KSD explain these associations.
ProQuest ID
Recommended Citation
Crivelli, Joseph, "Associations Of Social Determinants Of Health, Dietary Patterns, And Kidney Stone Disease Prevalence In A Pooled Analysis Of Nhlbi Cohort Studies" (2025). All ETDs from UAB. 7272.
https://digitalcommons.library.uab.edu/etd-collection/7272
