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CUAJ %u2022 FEBRUARY 2025 %u2022 VOLUME 19, ISSUE 2 59Kidney stone trendsrise in surgical treatment rates for kidney stones among women compared to men in the same time period.5The rising trend of kidney stones among women is concerning, complex, and multifactorial. One possible explanation is the rising rates of obesity. In the last two decades, the prevalence of obesity in U.S. adults increased from 30.5% to 42.4%.6 Notably, the prevalence of severe obesity was higher among women. Obesity has been tied to an increase in the concentrations of uric acid and calcium in the urine, contributing to stone formation.7 An evaluation of NHANES data from 2011%u20132018 also demonstrated that a higher total fat percentage is associated with a higher prevalence of stone disease.8 Moreover, obese women might also be at a higher risk of forming stones compared with obese men. A previous study determined that the relative risk of incident stones in obese men is 1.27 vs. that in normal weight men, whereas in obese women the risk was up to 2.09 times higher than in normal weight women.9 Metabolic syndrome, which is closely linked to hypertension and diabetes, has been associated with increased risk of kidney stones.10 Insulin resistance in diabetes is associated with increased intestinal absorption and renal excretion of calcium. Furthermore, diabetic stone formers excrete more oxalate than non-diabetic patients, all of which increases the risk of calcium oxalate stones.11 Metabolic syndrome also induces a series of inflammatory responses that precipitate calcification through the expression of monocyte chemoattractant protein 1, osteopontin, and macrophage infiltration.12 These inflammatory cascades cause an increase in reactive oxygen species (ROS) that is linked to calcification not Table 1. Trends in kidney stone prevalence in U.S. adults, 2007%u20132020*Groups 2007%u20132008 2009%u20132010 2011%u20132012 2013%u20132014 2015%u20132016 2017%u20132020 pAll subjects 8.9 (0.6) 8.8 (0.4) 8.5 (0.6) 10.1 (0.5) 11.5 (0.5) 9.9 (0.6) 0.23SexFemale 6.5 (0.5) 7.7 (0.5) 8.9 (1.0) 9.4 (0.8) 10.1 (0.9) 9.1 (0.9) 0.01Male 11.5 (0.9) 9.9 (0.8) 8.1 (0.8) 10.9 (0.9) 13.1 (0.6) 10.8 (0.9) 0.59Age20%u201339 4.7 (0.7) 5.1 (0.7) 5.1 (0.6) 6.1 (0.6) 7.3 (0.8) 6.4 (0.7) 0.1240%u201364 10.7 (0.9) 10.0 (0.7) 9.9 (0.8) 12.3 (1.2) 13.2 (1.0) 11.7 (1.1) 0.4865+ 13.3 (1.1) 13.6 (1.2) 11.8 (1.1) 12.8 (1.1) 15.6 (1.1) 12.3 (0.9) 0.47RaceMexican American 5.7 (0.7) 5.1 (1.0) 8.5 (1.2) 7.2 (1.1) 8.1 (0.9) 7.8 (0.8) 0.06Other Hispanic 8.7 (0.9) 7.8 (0.9) 8.6 (1.6) 7.3 (0.6) 11.9 (1.6) 10.2 (1.4) 0.37White 10.2 (0.7) 10.3 (0.5) 9.4 (0.9) 12.1 (0.8) 13.3 (0.8) 11.1 (0.8) 0.45Black 4.3 (0.8) 4.4 (0.6) 4.3 (0.5) 5.2 (0.6) 6.4 (0.5) 5.8 (0.6) 0.14Other/multirace 5.9 (1.8) 6.0 (1.5) 7.0 (1.0) 5.8 (0.8) 8.9 (1.7) 8.6 (1.0) 0.24*Values are percent (standard error).Figure 1. Trends in kidney stone prevalence in U.S. adults: A) among all participants; B) by age group; C) by sex; and D) by race/ethnicity. Plotted values are percentage (standard error).