Urolithiasis in immigrant groups: a nationwide cohort study in Sweden

Figures & data

Table 1. Baseline characteristics and incident cases of urolithiasis in the study population.

	First generation individuals				Second generation individuals
	Population		Events		Population		Events
	No.	%	No	%	No.	%	No	%
Total population	6452996		101302		8399203		84216
Upper urolithiasis			87695	86.6			67374	80.0
Lower urolithiasis			13456	13.3			5759	6.8
Other disease with urolithiasis			151	0.1			11083	13.3
Gender
Males	3053439	47.3	71173	70.3	4292637	51.1	58830	69.9
Females	3399557	52.7	30129	29.7	4106566	48.9	25386	30.1
Immigrant status*		0.0
Swedish	5309659	82.3	87003	85.9	6708819	79.9	75520	89.7
Foreign born	1143337	17.7	14299	14.1	1690384	20.1	6696	8.0
Educational level
≤9	2018070	31.3	36302	35.8	3296804	39.3	25450	30.2
10–12	1629336	25.2	29081	28.7	1477060	17.6	27098	32.2
>12	2805590	43.5	35919	35.5	3625339	43.2	31668	37.6
Region of residence
Large cities	2069959	32.1	34204	33.8	2046849	24.4	28885	34.3
Southern Sweden	2697908	41.8	45809	45.2	2653571	31.6	39647	47.1
Northern Sweden	1685129	26.1	21289	21.0	3698783	44.0	15684	18.6
Marital status
Married	4760887	73.8	79652	78.6	6243961	74.3	60068	71.3
Not married	1692109	26.2	21650	21.4	2155242	25.7	24148	28.7
Neighborhood deprivation
Low	891508	13.8	15554	15.4	939394	11.2	13847	16.4
Middle	3045109	47.2	51762	51.1	2978090	35.5	45156	53.6
High	722534	11.2	11475	11.3	684206	8.1	9415	11.2
Unknown	1793845	27.8	22511	22.2	3797513	45.2	15798	18.8
Hospital diagnosis of COPD
No	6163920	95.5	94448	93.2	7978729	95.0	79191	94.0
Yes	289076	4.5	6854	6.8	420474	5.0	5025	6.0
Hospital diagnosis of obesity
No	6367591	98.7	99366	98.1	8282999	98.6	82139	97.5
Yes	85405	1.3	1936	1.9	116204	1.4	2077	2.5
Hospital diagnosis of CHD
No	5918432	91.7	84261	83.2	8180756	97.4	71883	85.4
Yes	534564	8.3	17041	16.8	218447	2.6	12333	14.6
Hospital diagnosis of diabetes
No	6102823	94.6	89380	88.2	8176388	97.3	72161	85.7
Yes	350173	5.4	11922	11.8	222815	2.7	12055	14.3
Hospital diagnosis of alcohol-related diseases
No	6316607	97.9	99512	98.2	8213844	97.8	82033	97.4
Yes	136389	2.1	1790	1.8	185359	2.2	2183	2.6
Hospital diagnosis of stroke
No	6080958	94.2	91143	90.0	8265492	98.4	77930	92.5
Yes	372038	5.8	10159	10.0	133711	1.6	6286	7.5
Hospital diagnosis of hypertension
No	5692192	88.2	75121	74.2	7945999	94.6	60893	72.3
Yes	760804	11.8	26181	25.8	453204	5.4	23323	27.7
Hospital diagnosis of heart failure
No	6128396	95.0	94192	93.0	8321619	99.1	79383	94.3
Yes	324600	5.0	7110	7.0	77584	0.9	4833	5.7
Hospital diagnosis of atrial fibrillation
No	6085599	94.3	91034	89.9	8260858	98.4	77717	92.3
Yes	367397	5.7	10268	10.1	138345	1.6	6499	7.7
Hospital diagnosis of gout
No	6419641	99.5	100102	98.8	8380760	99.8	82760	98.3
Yes	33355	0.5	1200	1.2	18443	0.2	1456	1.7
Hospital diagnosis of hyperlipidemia
No	6335796	98.2	96923	95.7	8384066	99.8	72832	86.5
Yes	117200	1.8	4379	4.3	15137	0.2	11384	13.5
Hospital diagnosis of ESRD
No	6432973	99.7	100659	99.4	8308752	98.9	80166	95.2
Yes	20023	0.3	643	0.6	90451	1.1	4050	4.8
All	6452996	100.0	101302	100.0	8399203	100.0	84216	100.0

* Immigrant status in the second-generation individuals based on the country of birth of parents.

Table 2a. HR of Urolithiasis in first-generation male immigrants.

	Model 1			Model 2			Model 3
	HR	95% CI		HR	95% CI		HR	95% CI
Sweden	1			1			1
All male immigrants	1.02	1.00	1.04	1.07	1.05	1.10	1.06	1.04	1.09
Nordic countries	0.54	0.52	0.57	0.55	0.53	0.57	0.56	0.53	0.58
Denmark	0.80	0.74	0.87	0.80	0.74	0.87	0.82	0.76	0.89
Finland	0.48	0.46	0.51	0.49	0.47	0.52	0.49	0.47	0.52
Iceland	0.28	0.19	0.41	0.28	0.19	0.42	0.30	0.20	0.44
Norway	0.58	0.53	0.65	0.60	0.54	0.66	0.61	0.55	0.68
Southern Europe	1.01	0.94	1.08	1.03	0.96	1.11	1.06	0.99	1.14
France	1.00	0.81	1.24	1.04	0.84	1.29	1.06	0.86	1.32
Greece	0.98	0.87	1.10	1.00	0.89	1.12	1.04	0.93	1.17
Italy	0.90	0.78	1.04	0.94	0.81	1.09	0.95	0.82	1.11
Spain	1.20	1.00	1.42	1.23	1.03	1.47	1.28	1.07	1.52
Other Southern European countries	1.23	1.00	1.52	1.22	0.99	1.50	1.24	1.01	1.54
Western Europe	0.87	0.82	0.93	0.88	0.83	0.94	0.89	0.84	0.95
The Netherlands	0.87	0.69	1.08	0.89	0.71	1.11	0.91	0.73	1.13
UK and Ireland	0.65	0.56	0.75	0.66	0.57	0.76	0.68	0.59	0.79
Germany	0.97	0.89	1.06	0.99	0.90	1.07	0.99	0.91	1.07
Austria	1.08	0.91	1.28	1.11	0.93	1.32	1.11	0.93	1.31
Other Western European countries	0.72	0.53	0.97	0.75	0.56	1.01	0.77	0.57	1.04
Eastern Europe	1.97	1.90	2.05	1.90	1.83	1.97	1.85	1.78	1.92
Bosnia	2.23	2.09	2.39	2.19	2.05	2.34	2.11	1.97	2.25
Former Yugoslavia	1.76	1.68	1.85	1.71	1.63	1.80	1.68	1.59	1.76
Croatia	1.54	1.26	1.88	1.45	1.19	1.77	1.44	1.18	1.76
Romania	2.10	1.85	2.39	2.06	1.81	2.35	2.02	1.78	2.30
Bulgaria	1.92	1.52	2.43	1.90	1.51	2.41	1.91	1.51	2.41
Other Eastern European countries	3.86	3.41	4.37	3.57	3.15	4.04	3.46	3.06	3.92
Baltic countries	0.89	0.75	1.04	0.91	0.77	1.07	0.90	0.76	1.06
Estonia	0.75	0.62	0.92	0.78	0.64	0.95	0.77	0.63	0.94
Latvia	1.38	1.03	1.84	1.41	1.06	1.88	1.39	1.04	1.85
Central Europe	1.47	1.38	1.57	1.46	1.37	1.55	1.43	1.34	1.53
Poland	1.69	1.56	1.84	1.67	1.54	1.82	1.65	1.52	1.80
Other Central European countries	1.08	0.89	1.30	1.10	0.91	1.33	1.09	0.91	1.32
Hungary	1.30	1.16	1.47	1.30	1.15	1.47	1.27	1.13	1.43
Africa	1.39	1.30	1.49	1.40	1.30	1.50	1.37	1.28	1.47
Northern America	0.67	0.57	0.78	0.69	0.59	0.80	0.71	0.61	0.83
Latin America	1.65	1.54	1.76	1.67	1.56	1.79	1.69	1.58	1.81
Chile	1.99	1.84	2.16	2.02	1.86	2.19	2.03	1.87	2.20
South America	1.16	1.02	1.31	1.19	1.05	1.35	1.21	1.07	1.38
Asia	2.58	2.52	2.65	2.54	2.47	2.61	2.48	2.41	2.55
Turkey	2.29	2.15	2.44	2.23	2.09	2.38	2.18	2.05	2.33
Lebanon	2.92	2.71	3.15	2.86	2.65	3.09	2.76	2.56	2.98
Iran	2.46	2.32	2.59	2.48	2.34	2.62	2.47	2.33	2.61
Iraq	4.14	3.97	4.32	4.12	3.94	4.30	3.93	3.76	4.11
Other Asian countries	1.61	1.52	1.70	1.60	1.51	1.70	1.57	1.48	1.66
Russia	1.47	1.26	1.73	1.50	1.28	1.77	1.48	1.26	1.74

Model 1: adjusted for age and region of residence in Sweden; Model 2: adjusted for age, region of residence in Sweden, educational level, and marital status, and neighborhood deprivation; Model 3: model 2 + comorbidities.Bold values are statistically significant.

Table 2b. HR of Urolithiasis in first-generation female immigrants.

	Model 1			Model 2			Model 3
	HR	95% CI		HR	95% CI		HR	95% CI
Sweden	1			1			1
All female immigrants	1.07	1.03	1.10	1.14	1.10	1.18	1.12	1.08	1.16
Nordic countries	0.63	0.60	0.66	0.61	0.58	0.64	0.61	0.58	0.64
Denmark	0.84	0.74	0.95	0.82	0.73	0.93	0.85	0.75	0.96
Finland	0.60	0.56	0.63	0.58	0.54	0.62	0.57	0.54	0.61
Iceland	0.38	0.24	0.61	0.38	0.24	0.60	0.41	0.26	0.65
Norway	0.65	0.57	0.74	0.64	0.56	0.72	0.65	0.57	0.74
Southern Europe	0.93	0.81	1.07	0.91	0.79	1.05	0.98	0.85	1.12
France	0.73	0.48	1.11	0.77	0.51	1.17	0.81	0.54	1.23
Greece	0.95	0.77	1.18	0.92	0.74	1.13	1.00	0.81	1.24
Italy	0.83	0.58	1.17	0.83	0.58	1.17	0.89	0.63	1.26
Spain	1.28	0.93	1.75	1.28	0.94	1.75	1.35	0.98	1.84
Other Southern European countries	0.84	0.55	1.29	0.82	0.54	1.26	0.85	0.55	1.30
Western Europe	0.95	0.86	1.05	0.97	0.88	1.07	0.99	0.90	1.09
The Netherlands	0.82	0.55	1.23	0.85	0.57	1.27	0.89	0.60	1.33
UK and Ireland	0.56	0.42	0.75	0.58	0.43	0.77	0.62	0.46	0.83
Germany	1.10	0.98	1.24	1.12	1.00	1.26	1.12	1.00	1.26
Austria	1.24	0.92	1.68	1.26	0.93	1.70	1.27	0.94	1.72
Other Western European countries	0.42	0.22	0.81	0.44	0.23	0.84	0.46	0.24	0.89
Eastern Europe	2.29	2.18	2.40	2.26	2.15	2.37	2.22	2.12	2.34
Bosnia	2.29	2.10	2.49	2.36	2.16	2.57	2.31	2.12	2.53
Former Yugoslavia	2.27	2.12	2.42	2.19	2.05	2.34	2.16	2.02	2.31
Croatia	1.41	1.04	1.91	1.41	1.04	1.91	1.42	1.05	1.93
Romania	2.13	1.80	2.52	2.23	1.89	2.64	2.20	1.86	2.60
Bulgaria	2.47	1.87	3.26	2.57	1.94	3.39	2.60	1.97	3.43
Other Eastern European countries	3.73	3.16	4.40	3.55	3.00	4.20	3.50	2.96	4.14
Baltic countries	0.76	0.59	0.97	0.80	0.63	1.03	0.78	0.61	1.00
Estonia	0.63	0.46	0.87	0.66	0.48	0.92	0.65	0.47	0.90
Latvia	1.08	0.74	1.59	1.17	0.80	1.72	1.15	0.78	1.69
Central Europe	1.51	1.39	1.64	1.55	1.43	1.68	1.54	1.42	1.68
Poland	1.63	1.49	1.79	1.68	1.53	1.84	1.68	1.53	1.84
Other Central European	1.06	0.80	1.41	1.11	0.84	1.48	1.13	0.85	1.50
Hungary	1.34	1.10	1.63	1.38	1.13	1.68	1.34	1.10	1.63
Africa	1.43	1.29	1.59	1.39	1.25	1.54	1.37	1.23	1.52
Northern America	0.63	0.49	0.81	0.66	0.52	0.85	0.70	0.54	0.90
Latin America	2.00	1.84	2.17	1.97	1.81	2.14	1.94	1.78	2.11
Chile	2.41	2.18	2.67	2.35	2.12	2.60	2.26	2.04	2.50
South America	1.47	1.27	1.71	1.50	1.30	1.74	1.52	1.31	1.76
Asia	2.07	1.99	2.15	2.03	1.95	2.11	1.99	1.91	2.08
Turkey	2.41	2.20	2.64	2.23	2.03	2.44	2.17	1.98	2.38
Lebanon	2.43	2.16	2.73	2.30	2.05	2.60	2.25	2.00	2.53
Iran	2.24	2.06	2.44	2.34	2.15	2.55	2.32	2.13	2.52
Iraq	3.28	3.07	3.51	3.28	3.06	3.52	3.14	2.93	3.36
Other Asian countries	1.28	1.19	1.37	1.26	1.18	1.36	1.26	1.17	1.36
Russia	1.25	1.04	1.49	1.34	1.12	1.61	1.33	1.11	1.59

Model 1: adjusted for age and region of residence in Sweden; Model 2: adjusted for age, region of residence in Sweden, educational level, and marital status; Model 3: model 2 + neighborhood deprivation.Bold values are statistically significant.

Table 3a. HR of Urolithiasis in second-generation male immigrants.

	Model 1			Model 2			Model 3
	HR	95% CI		HR	95% CI		HR	95% CI
Sweden	1			1			1
All male immigrants	0.93	0.90	0.96	0.95	0.92	0.98	0.95	0.92	0.98
Nordic countries	0.93	0.89	0.96	0.94	0.90	0.97	0.94	0.90	0.98
Denmark	1.24	1.15	1.35	1.24	1.14	1.34	1.23	1.13	1.33
Finland	0.77	0.73	0.82	0.78	0.74	0.83	0.80	0.76	0.85
Iceland	0.14	0.04	0.55	0.15	0.04	0.61	0.16	0.04	0.64
Norway	1.07	0.99	1.15	1.08	1.00	1.16	1.06	0.98	1.14
Southern Europe	1.02	0.88	1.19	1.08	0.93	1.26	1.09	0.94	1.27
France	1.11	0.78	1.58	1.18	0.83	1.68	1.31	0.92	1.86
Greece	0.84	0.62	1.14	0.90	0.66	1.22	0.93	0.69	1.26
Italy	1.19	0.94	1.50	1.25	0.98	1.58	1.19	0.94	1.50
Spain	1.00	0.66	1.52	1.06	0.69	1.60	1.11	0.73	1.68
Other Southern European countries	0.65	0.29	1.44	0.67	0.30	1.48	0.63	0.29	1.41
Western Europe	1.07	0.99	1.16	1.10	1.02	1.19	1.12	1.04	1.21
The Netherlands	0.97	0.69	1.38	1.00	0.71	1.42	1.00	0.71	1.42
UK and Ireland	0.57	0.41	0.79	0.61	0.44	0.85	0.61	0.44	0.84
Germany	1.13	1.03	1.24	1.15	1.05	1.26	1.19	1.08	1.30
Austria	1.33	1.07	1.64	1.36	1.10	1.68	1.25	1.01	1.54
Other Western European countries	0.85	0.54	1.34	0.90	0.57	1.41	0.99	0.63	1.55
Eastern Europe	0.86	0.73	1.00	0.89	0.76	1.03	0.85	0.73	1.00
Bosnia	0.58	0.35	0.97	0.69	0.41	1.14	0.64	0.39	1.06
Former Yugoslavia	0.86	0.72	1.04	0.87	0.72	1.05	0.84	0.69	1.00
Croatia	1.04	0.47	2.31	1.02	0.46	2.28	0.99	0.45	2.21
Romania	1.01	0.64	1.61	1.06	0.67	1.68	1.06	0.67	1.68
Bulgaria	1.14	0.48	2.75	1.23	0.51	2.95	1.30	0.54	3.12
Other Eastern European countries	1.04	0.34	3.23	1.06	0.34	3.29	0.95	0.31	2.96
Baltic countries	0.89	0.78	1.02	0.92	0.81	1.05	0.97	0.85	1.10
Estonia	0.83	0.72	0.96	0.86	0.74	0.99	0.92	0.79	1.06
Latvia	1.25	0.94	1.67	1.30	0.98	1.74	1.24	0.93	1.65
Central Europe	1.39	1.24	1.56	1.41	1.26	1.58	1.40	1.24	1.57
Poland	1.48	1.26	1.74	1.51	1.29	1.78	1.45	1.23	1.70
Other Central European countries	1.18	0.90	1.54	1.20	0.92	1.57	1.25	0.95	1.63
Hungary	1.40	1.14	1.71	1.39	1.14	1.71	1.40	1.14	1.72
Africa	0.40	0.24	0.65	0.44	0.27	0.71	0.43	0.26	0.71
Northern America	0.90	0.78	1.03	0.92	0.80	1.05	0.92	0.80	1.05
Latin America	0.65	0.46	0.91	0.69	0.49	0.96	0.69	0.49	0.96
Chile	0.71	0.46	1.09	0.75	0.49	1.15	0.76	0.49	1.16
South America	0.56	0.32	0.96	0.60	0.35	1.03	0.59	0.34	1.02
Asia	0.54	0.44	0.65	0.58	0.48	0.70	0.56	0.46	0.68
Turkey	0.80	0.60	1.05	0.84	0.64	1.11	0.82	0.62	1.08
Lebanon	0.30	0.12	0.71	0.32	0.14	0.78	0.30	0.13	0.72
Iran	0.27	0.13	0.54	0.29	0.15	0.58	0.28	0.14	0.56
Iraq	0.24	0.11	0.53	0.28	0.13	0.61	0.25	0.11	0.56
Other Asia countries	0.57	0.42	0.77	0.62	0.46	0.84	0.60	0.44	0.81
Russia	0.89	0.71	1.11	0.90	0.72	1.14	0.94	0.75	1.18

Model 1: adjusted for age and region of residence in Sweden; Model 2: adjusted for age, region of residence in Sweden, educational level, and marital status, and neighborhood deprivation; Model 3: model 2 + comorbidities.Bold values are statistically significant.

Table 3b. HR of Urolithiasis in second-generation female immigrants.

	Model 1			Model 2			Model 3
	HR	95% CI		HR	95% CI		HR	95% CI
Sweden	1			1			1
All female immigrants	0.98	0.93	1.03	1.01	0.96	1.06	1.01	0.96	1.06
Nordic countries	1.02	0.96	1.08	1.03	0.97	1.09	1.03	0.97	1.09
Denmark	1.28	1.13	1.44	1.26	1.12	1.42	1.31	1.16	1.48
Finland	0.92	0.85	0.99	0.94	0.87	1.01	0.93	0.86	1.01
Iceland	0.15	0.02	1.03	0.16	0.02	1.13	0.17	0.02	1.23
Norway	1.09	0.97	1.22	1.09	0.97	1.22	1.07	0.96	1.20
Southern Europe	0.87	0.68	1.11	0.93	0.73	1.19	0.95	0.74	1.21
France	0.82	0.44	1.52	0.90	0.48	1.67	0.96	0.52	1.78
Greece	0.70	0.43	1.15	0.76	0.46	1.23	0.81	0.49	1.32
Italy	1.06	0.72	1.56	1.13	0.77	1.66	1.12	0.76	1.64
Spain	0.83	0.41	1.66	0.88	0.44	1.76	0.81	0.41	1.63
Other Southern European countries	0.85	0.32	2.26	0.85	0.32	2.27	0.93	0.35	2.47
Western Europe	1.15	1.03	1.29	1.20	1.07	1.35	1.20	1.07	1.34
The Netherlands	1.56	1.03	2.37	1.64	1.08	2.48	1.41	0.93	2.14
UK and Ireland	0.78	0.51	1.18	0.84	0.55	1.28	0.93	0.61	1.41
Germany	1.22	1.07	1.39	1.26	1.10	1.44	1.24	1.08	1.41
Austria	0.88	0.59	1.30	0.92	0.62	1.36	1.01	0.68	1.49
Other Western European countries	1.24	0.70	2.19	1.35	0.76	2.37	1.34	0.76	2.36
Eastern Europe	0.90	0.72	1.13	0.93	0.74	1.16	0.93	0.74	1.16
Bosnia	0.51	0.23	1.14	0.61	0.27	1.35	0.57	0.26	1.27
Former Yugoslavia	0.96	0.74	1.24	0.96	0.74	1.24	0.96	0.74	1.25
Croatia	1.72	0.72	4.13	1.68	0.70	4.03	1.81	0.75	4.34
Romania	0.89	0.42	1.86	0.94	0.45	1.97	0.91	0.43	1.91
Bulgaria	0.89	0.22	3.57	0.97	0.24	3.90	1.08	0.27	4.30
Other Eastern European countries
Baltic countries	0.66	0.52	0.83	0.70	0.55	0.88	0.72	0.57	0.91
Estonia	0.69	0.54	0.88	0.73	0.57	0.93	0.75	0.59	0.96
Latvia	0.49	0.24	0.97	0.52	0.26	1.04	0.54	0.27	1.08
Central Europe	1.31	1.10	1.56	1.33	1.11	1.58	1.32	1.11	1.58
Poland	1.09	0.83	1.44	1.11	0.84	1.46	1.13	0.86	1.49
Other Central European countries	1.05	0.69	1.62	1.08	0.71	1.66	1.10	0.72	1.68
Hungary	1.81	1.39	2.37	1.82	1.39	2.37	1.72	1.32	2.25
Africa	0.30	0.14	0.67	0.33	0.15	0.73	0.33	0.15	0.72
Northern America	0.79	0.64	0.99	0.82	0.65	1.02	0.88	0.71	1.10
Lartin America	0.40	0.22	0.75	0.42	0.22	0.78	0.43	0.23	0.80
Chile	0.55	0.28	1.10	0.56	0.28	1.13	0.56	0.28	1.12
South America	0.19	0.05	0.76	0.20	0.05	0.81	0.22	0.06	0.88
Asia	0.39	0.28	0.54	0.41	0.30	0.57	0.41	0.29	0.56
Turkey	0.72	0.47	1.10	0.74	0.48	1.13	0.74	0.48	1.14
Lebanon	0.12	0.02	0.84	0.12	0.02	0.88	0.12	0.02	0.88
Iran	0.22	0.07	0.67	0.23	0.07	0.71	0.21	0.07	0.66
Iraq	0.08	0.01	0.56	0.09	0.01	0.64	0.09	0.01	0.61
Other Asian countries	0.35	0.20	0.62	0.38	0.21	0.66	0.37	0.21	0.66
Russia	1.13	0.83	1.53	1.17	0.86	1.58	1.13	0.84	1.54

Model 1: adjusted for age and region of residence in Sweden; Model 2: adjusted for age, region of residence in Sweden, educational level, and marital status; Model 3: model 2 + neighborhood deprivation.Bold values are statistically significant.