Kidney stone disease (KSD) results in billions of dollars in healthcare costs per year, creates large economic losses due to decreased work productivity, and negatively impacts quality of life. Black and Hispanic individuals historically have a lower prevalence of KSD compared to White individuals; however, the rate of increase in the prevalence of KSD among Black and Hispanic individuals is greater than that among White individuals. There is evidence that KSD risk is influenced by social determinants of health (SDOH), potentially contributing to the disproportionate rise in KSD risk in racial and ethnic minority populations who bear the greatest burden of adverse SDOH; however, the extent to which SDOH associate with kidney stone risk in diverse populations has been understudied. Diet and lifestyle clearly influence KSD risk. It is important to describe how all of these factors, as well as their temporal changes, contribute to KSD risk in racial and ethnic minority groups. The overall objective of this project is to assess associations of SDOH with KSD risk in racially and ethnically diverse populations, the contribution of dietary quality to these associations, and the effect of adopting a healthy dietary pattern on KSD risk. To achieve this objective, we aim to: 1) Identify risk factors for KSD prevalence in a racially and ethnically diverse pooled cohort from five observational studies; 2) Measure the associations of temporal changes in risk factors (e.g., dietary pattern, anthropometrics, SDOH, and associated chronic medical conditions) with KSD incidence among participants of Coronary Artery Risk Development in Young Adults (CARDIA; a cohort of Black and White adults with over 30 years of follow-up); and 3) Determine the extent to which adopting a healthy dietary pattern, namely a Dietary Approaches to Stop Hypertension (DASH)-style diet, improves 24-hour urinary stone risk parameters among individuals with KSD through a controlled diet study enrolling CARDIA participants. The proposed research leverages key resources at our institution, including the Birmingham Field Center for CARDIA and the Bionutrition Unit of the Center for Clinical and Translational Science (CCTS). We expect to elucidate the magnitude of the social and dietary determinants of KSD risk in racially and ethnically diverse cohorts, and determine the effect of a DASH-style diet on urinary stone risk factors. We also expect that this will provide the foundation for future independent grant efforts to develop more effective preventive care strategies for disadvantaged patients with KSD. This K23 award will provide the PI with training in biostatistics/epidemiology, SDOH, nutrition/dietetics, and patient-oriented kidney stone research, which will be critical for his career development and long-term goal of becoming an independent investigator. Career development activities will include a Masters of Science in Public Health in Applied Epidemiology, which will incorporate coursework in health inequities and nutrition research; the Clinical Investigator Training Program which offers training on clinical trial oversight; and regular interactions with a team of mentors and collaborators with complementary expertise in SDOH, nutrition, analysis of cohort studies and clinical trials, and KSD epidemiology/prevention.

The goal of this proposal is to identify the contributions of social and dietary factors to kidney stone risk in racially and ethnically diverse populations. If successful, the proposed research will provide insight into the reasons for rising kidney stone prevalence in racial and ethnic minority groups and help develop more effective strategies for secondary prevention. The proposed research corresponds to NIDDK’s scientific goals to identify and characterize factors that affect human health in diverse populations; and to analyze the links between biology, behavior, and the environment, including social determinants of health and structural factors, that contribute to disease heterogeneity and health disparities.