S1770 Racial Disparities and Demographic Profile of Nephrolithiasis Among Adults With Crohn’s Disease: A Multicenter Analysis Using Epic Cosmos Data

Introduction: Patients with Crohn’s disease (CD) are at increased risk for nephrolithiasis due to multifactorial etiologies including malabsorption, chronic inflammation, and altered oxalate handling. However, population-level data on nephrolithiasis prevalence across demographic subgroups within the Crohn’s population are limited. We aimed to determine the prevalence of nephrolithiasis among adults with Crohn’s disease, stratified by race, legal sex, and age, using real-world evidence from the Epic Cosmos data network. Methods: This retrospective cohort study analyzed de-identified EHR data from Epic Cosmos, which aggregates patient-level data across >200 U.S. health systems. We included adult patients (≥18 years) with a diagnosis of Crohn’s disease between April 30, 2017, and April 30, 2025. Nephrolithiasis diagnoses were identified via problem list and encounter documentation. Prevalence was expressed as percentages (rate per 100,000 divided by 1,000), stratified by race, sex, and age bands. Results: Among 7.7 million adults with Crohn’s disease, the overall prevalence of nephrolithiasis was 7.74%. Men had a higher prevalence (8.81%) compared to women (6.90%). White patients with crohn’s disease exhibited the highest overall burden of nephrolithiasis at 8.28%, followed by American Indian or Alaska native patients at 7.57%, and those identifying as other races at 7.48%. The lowest rates were observed in Asian patients (4.83%) and black or African American patients (4.91%). Asian females had the lowest sex-specific prevalence at 3.79%.Prevalence increased with age across all racial groups, peaking in the 75–84 year age group, with White males reaching a maximum prevalence of 14.7%. These data suggest a significant nephrolithiasis burden among aging Crohn’s populations, with distinct racial and sex-based disparities. Conclusion: In this large multicenter analysis of Crohn’s disease patients, nephrolithiasis affected nearly 1 in 13 individuals, with a disproportionate burden among older, White, and American Indian/Alaska Native populations. These findings highlight the importance of kidney stone risk stratification in Crohn’s care, particularly in aging male populations. Further studies are needed to assess modifiable contributors and preventive interventions in high-risk groups.