Health Outcomes Research| Volume 79, ISSUE 1, P86-92, January 2012

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Increased Risk of Urinary Tract Calculi Among Patients With Diabetes Mellitus—A Population-based Cohort Study

  • Hsin-Shui Chen
    Department of Physical Medicine and Rehabilitation, China Medical University, Bei-Gang Hospital, Yun-Lin, Taiwan
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  • Li-Ting Su
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
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  • Shinn-Zong Lin
    Department of Physical Medicine and Rehabilitation, China Medical University, Bei-Gang Hospital, Yun-Lin, Taiwan

    Institute of Immunology, China Medical University Hospital, Taichung, Taiwan
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  • Fung-Chang Sung
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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  • Ming-Chung Ko
    Reprint requests: Ming-Chung Ko, M.D., M.Sc., Department of Surgery, Taipei City Hospital, 145 Zheng Zhou Road, Taipei, Taiwan 103
    Department of Surgery, Taipei City Hospital, Taipei, Taiwan
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  • Chung-Yi Li
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Published:November 25, 2011DOI:


      To investigate the inter-relationship among diabetes, urinary tract infection (UTI), and urinary tract calculi (UTC).


      This study used Taiwan's National Health Insurance claims data of ambulatory care visits and hospitalizations. A total of 12,257 newly diagnosed diabetes cases in 2000-2002 and 96,781 controls were followed to the end of 2007. The person-year approach with Poisson assumption was used to estimate the incidence density (ID) of UTC by diabetic status. Relative risk of UTC in relation to diabetes and UTI were estimated from Cox proportional hazard model with adjustment for sociodemographic variables and comorbidities.


      Over nearly 8 years of follow-up, 8.9% of diabetes and 7.2% of control subjects sought ambulatory care or were hospitalized for UTC, representing the ID of 14.4 and 11.4 per 1000 person-years, respectively. The multivariate analysis indicated that UTC risk was independently associated with diabetes (hazard ratio 1.18, 95% CI 1.10-1.27) and UTI (HR 1.68, 95% CI 1.60-1.76). The hazard ratio of UTC in relation to diabetes in men and women without UTI was 1.24 and 1.26, respectively. Diabetes may further increase the rate of UTC in women with UTI, with an hazard ratio increased from 1.79-2.12. Such additive effect by diabetes in men with UTI was only marginal (HR 1.68 vs 1.67).


      This cohort study provides epidemiologic support for the causal association between diabetes and UTC, which is independent of UTI. In addition, female patients with UTI accompanied by diabetes tended to be associated with a greater rate of UTC.
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      • Editorial Comment
        UrologyVol. 79Issue 1
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          Diabetes mellitus has been associated with an increased risk of kidney stone formation in a number of epidemiologic studies.1-3 With the exception of a study from Turkey,2 these data reflect the findings from a population of American adults, with presumably Western trends in diet and lifestyle. The present study not only provides additional evidence for the link between diabetes mellitus and kidney stone formation but also extends it to a large, Taiwanese cohort. It also reinforces the notion that nephrolithiasis is a reflection of systemic disease—an increased incidence of stone disease is seen in patients with diabetes mellitus, as well as other common systemic conditions, such as metabolic syndrome and hypertension.
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