Trends of Urolithiasis in China: A National Study Based on Hospitalized Patients from 2013 to 2018

The aim of this study was to explore the chronological trends in clinical features and utilization of healthcare resources for hospitalized patients with urolithiasis in China.

Patients with urolithiasis were extracted from the Hospital Quality Monitoring System, a national database of hospitalized patients in China, based on the International Classification of Diseases, Tenth Revision, codes. Variables including demographic characteristics, comorbidities, treatment modalities for urolithiasis, length of hospital stay, and expenditures were collected and analyzed.

Among 79.8 million hospitalized patients, 3.5 million were diagnosed with urolithiasis with an increasing trend (from 3.0% in 2013 to 4.0% in 2018). Most of these patients had upper urinary tract calculi (76.6% in 2013 and 81.7% in 2018). Middle-aged patients (46-65 years) constituted the largest proportion with a stable trend (from 46.9% in 2013 to 48.8% in 2018), while the proportion of older patients (>65 years) showed an increasing trend (from 23.7% in 2013 to 27.4% in 2018). The percentages of gout/hyperuricemia, hypertension, diabetes, and cardiovascular disease among the hospitalized patients with urolithiasis increased steadily, with the sharpest increases in patients from rural areas. Overall, 656,952 patients (18.9%) received surgical interventions for urolithiasis. The proportions of ureteroscopy and extracorporeal shockwave lithotripsy increased steadily during the 6-year study period, with simultaneous decreases in open surgery and percutaneous nephrolithotomy. The median length of hospital stay decreased from 10 days to 8 days. The cost of urolithiasis intervention accounted for 2.0% of the total hospitalization fee in 2013 and increased to 2.7% in 2018.

The analysis showed an increasing trend in the percentage of hospitalized patients with urolithiasis, accompanied by an increased percentage of the total hospitalization fee for urolithiasis intervention during the 6-year study period. Based on the increasing trends in the proportion of older patients (>65 years) and percentages of metabolic comorbidities among patients with urolithiasis, an increased burden of urolithiasis on the healthcare system in China is anticipated.