Trends in urolithiasis mortality in the United States, 1999-2024: a Joinpoint regression analysis of age, sex, race, and regional disparities.

BACKGROUND: Urolithiasis is traditionally considered a benign condition with extremely low mortality. However, recent evidence suggests a potential shift in this paradigm. This study aims to analyze urolithiasis mortality trends in the United States from 1999 to 2024, with a focus on demographic and geographic disparities. METHODS: Death certificate data for individuals aged 45 years and older were obtained from the CDC WONDER database. Urolithiasis-related deaths were identified using ICD-10 codes N20-N23. Age-adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression was employed to identify significant changes in mortality trends. Analyses were stratified by census region, sex, race/ethnicity, and age group. RESULT: From 1999 to 2024, the age-adjusted mortality rate for urolithiasis increased from 0.22 to 0.72 per 100,000 population. The rise was modest from 1999 to 2014, with an annual percent change of 1.94%, followed by a sharp acceleration from 2014 to 2024, when the annual percent change reached 8.54%. Substantial disparities were observed. The Northeast had the highest age-adjusted mortality rate at 0.85 per 100,000, while the Midwest experienced the fastest increase, with an average annual percent change of 5.42%. In 2024, the female age-adjusted mortality rate surpassed that of males (0.80 vs. 0.68 per 100,000). Non-Hispanic white people bore the heaviest burden, with an age-adjusted mortality rate of 0.86 per 100,000 and an average annual percent change of 5.71%. Hispanics exhibited a "mortality paradox," whereas non-Hispanic black people had the lowest rate at 0.36 per 100,000. Mortality increased with age: the highest rate was observed among those aged 85 years and older (5.72 per 100,000), and the fastest increase occurred in the 65-74 years age group, with an average annual percent change of 4.94%. CONCLUSION: Urolithiasis mortality in the United States has increased dramatically since 2014, with persistent disparities observed across region, sex, race, and age. These findings suggest that urolithiasis mortality in the United States has increased substantially since 2014, warranting increased public health attention. However, given the low absolute mortality rates and the inherent limitations of death certificate data, these findings should be interpreted as hypothesis-generating and require confirmation in future studies. Targeted interventions are needed for high-risk groups-including older adults, females, non-Hispanic white people, and individuals with metabolic syndrome-as well as for high-risk regions such as the Midwest and rural areas.