{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T08:28:23Z","timestamp":1791016103306,"version":"4.1.0"},"reference-count":25,"publisher":"American Public Health Association","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[1991,5]]},"abstract":"<jats:p> BACKGROUND: Urinary tract stones (stones) are believed to be unusually common in the southeastern United States but neither the incidence of nor the risk factors for stones are known. METHODS: In three well-defined occupational populations in eastern Tennessee, we assessed the prevalence, incidence, and cumulative incidence of stones and measured biochemical risk factors for lithogenesis. RESULTS: The age-adjusted prevalence of stones was 18.5 percent in Tennessee compared to 7.7 percent among White males in US NHANES (prevalence ratio 2.4, 95% CI 1.7, 3.3). The cumulative incidence (risk) was 27.8 percent by age 65, higher than in any other reported population. Risk factors were age, a family history, and urinary saturation with calcium-oxalate (COAX). Persons with a positive family history and the highest measured CAOX index had a predicted lifetime risk of 88.8 percent. Biochemical factors affecting lithogenesis were hypercalciuria, hyperoxaluria, and low urine volume. CONCLUSION: Future research should characterize the geographic boundaries of a southeastern \"stone-belt\" and explore genetic and dietary hypotheses that might explain it. <\/jats:p>","DOI":"10.2105\/ajph.81.5.587","type":"journal-article","created":{"date-parts":[[2008,11,29]],"date-time":"2008-11-29T13:17:08Z","timestamp":1227964628000},"page":"587-591","source":"Crossref","is-referenced-by-count":27,"title":["Urolithiasis in Tennessee: an occupational window into a regional problem."],"prefix":"10.2105","volume":"81","author":[{"given":"M J","family":"Thun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Schober","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"844","reference":[{"key":"p_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1956.02970150005002"},{"key":"p_2","first-page":"438","volume":"15","author":"Sierakowski R","year":"1978","journal-title":"Invest Urol"},{"key":"p_3","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)56370-3"},{"key":"p_4","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a113297"},{"key":"p_5","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1979.173"},{"key":"p_6","unstructured":"Thun MJ, Schober S, Stayner L, Wells V: Health Hazard Evaluation Report, Nuclear Fuel Services, US Dept of Health and Human Services, Public Health Service, National Institute for Occupational Safety and Health, HETA-86-381-1934. 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