Climate-related increase in the prevalence of urolithiasis in the United States

An unanticipated result of global warming is the likely northward expansion of the present-day southeastern U.S. kidney stone belt. The fraction of the U.S. population living in high-risk zones for nephrolithiasis will grow from 40% in 2000 to 56% by 2050, and to 70% by 2095. Predictions based on a climate model of intermediate severity warming (SRESa1b) indicate a climate-related increase of 1.6-2.2 million lifetime cases of nephrolithiasis by 2050, representing up to a 30% increase in some climate divisions. Nationwide, the cost increase associated with this rise in nephrolithiasis would be $0.9-1.3 billion annually (year-2000 dollars), representing a 25% increase over current expenditures. The impact of these changes will be geographically concentrated, depending on the precise relationship between temperature and stone risk. Stone risk may abruptly increase at a threshold temperature (nonlinear model) or increase steadily with temperature change (linear model) or some combination thereof. The linear model predicts increases by 2050 that are concentrated in California, Texas, Florida, and the Eastern Seaboard; the nonlinear model predicts concentration in a geographic band stretching from Kansas to Kentucky and Northern California, immediately south of the threshold isotherm.