To address this gap, we conducted the first nationwide assessment of USD prevalence and determinants in Mexico, deploying a mixed methodology integrating a systematic review, including gray literature, with an ecological analysis of the 2018 National Health and Nutrition Survey (ENSANUT).1 As mentioned, most of the evidence is not in the conventional Pubmed-indexed journal, hence the gray literature data acquisition. The ENSANUT, which is basically the Mexican version of the USA’s National Health and Nutrition Examination Survey, did for the first time in many years (if not ever) report USD in the 2018 dataset, which included 43,070 participants.
The ENSANUT analysis revealed a nationwide USD prevalence of 33.2 per 1,000 inhabitants. Subnational distribution exhibited a striking heterogeneity, with the south-southeast—especially the Yucatan Peninsula and the Gulf Coast—concentrating the highest prevalence. As expected, ambient temperature correlated moderately with USD prevalence, consistent with dehydration-driven lithogenic risk in warmer climates. However, this pattern was not deterministic. Several states with high temperatures displayed comparatively low USD prevalence, suggesting that climate likely interacts with other drivers. Mexico City illustrates this distinct paradigm, where a high prevalence of USD was observed in a large metropolitan area where heat alone is insufficient as a causal factor, and where, among endless possible factors, air pollution remains a plausible contributor.
Our estimates indicate that at least 4.4 million individuals in Mexico are living with USD, but a shared feeling of underestimation prevails. In any case, this conservative number translates already into a stressed healthcare system. Each urologist would be expected to look after 3,647 stone-formers (SF) on average, reaching up to 5,982 SF per urologist in high-burden regions such as Yucatan.
SF were older than non–SF (median 49 vs 42 years), and the peak prevalence occurred between 50 - 70 years. These findings might have been driven by the broad natural history of USD as a chronic disease and its increased cumulative risk through time. Although historically USD has been more prevalent in men, we found a female overtake in the gender distribution of 60% in the ENSANUT data and 55.9% in the appraised manuscripts. The increased risk of USD that comes with menopause was not a feasible explanation, and therefore, more in-depth studies are mandatory to understand this gender swap. We hypothesized, however, that the higher rate of urinary tract infections in women, and their integration into a workforce previously nearly restricted to men, may play a role.
A remarkable finding in our study is the correlation of the USD burden with the socioeconomic context. Across states, USD prevalence correlated with indicators of inequity (Gini coefficient) and poverty and extreme poverty, suggesting that social structure may shape lithogenic risk and/or its recognition. Similarly, an inverse correlation of USD with access to healthcare was observed. This striking finding backs up the possibility that limited healthcare access delays USD detection and treatment, allowing stones and metabolic abnormalities to remain clinically silent until complications and/or sequelae occur. We must stress that data derived from ecological studies cannot establish causality nor apply to the individual level, but collectively (i.e. population-level) it supports the public health framing of USD in Mexico as a metabolic disease embedded within structural and social determinants.
Key metabolic conditions, such as obesity, type 2 diabetes, and hypertension, were consistently associated with USD across both ENSANUT and systematically appraised literature. We previously reported the urinary metabolic profile of SF from the hot-spot for USD in Mexico – Yucatan – and found a distinctive biochemical signature: hypocitraturia dominates by far.2 This signature may not be exclusive to Yucatan, as recent abstracts presented in the Mexican Society of Urology meeting reported similar data; unfortunately, no citable documents exist. Our ongoing efforts to gather a more representative nationwide sample of SF will hopefully shine some light to the metabolic profile picture in Mexico soon.
This study has the inherent limitations of both the ecological and the survey-based designs: ENSANUT assesses USD via self-report, raising recall and misclassification concerns; stone composition and occupational exposures are not robustly captured; and ecological correlations cannot be translated into individual causal inference. Nonetheless, the consistency across data streams supports that, in Mexico, USD is common, heterogeneous, socially patterned, metabolically intertwined, and highly condensed in the south.
Written by: Mario Basulto Martínez, MD, MSc; Méndez-Molina R; Ayala-Muñoz C; Flores-Tapia JP; and Esqueda-Mendoza A.
- Department of Urology, Hospital Regional de Alta Especialidad de la Península de Yucatán – IMSS Bienestar; Merida, Mexico.
- Basulto-Martínez M, Méndez-Molina R, Mendoza-Arcila ME, Ayala-Muñoz C, Esqueda-Mendoza A, Flores-Tapia JP. Burden, sociodemographic determinants, and risk factors of urinary stone disease in Mexico: a comprehensive study. Urolithiasis, 54, 2 (2026).
- Mario Basulto-Martínez, Barbara Peña-Espinoza, Rafael Valdez-Ortiz, Rachel Escalante-Sosa, Juan Pablo Flores-Tapia, Marta Menjivar. High Prevalence of Hypocitraturia in Stone Formers from the Maya Region of Yucatan, Mexico. Archives of Medical Research, 53, 1 (2022): 69-78.