Urolithiasis-related healthcare utilization among adults in Mexico: a nationwide analysis of emergency department visits, hospitalizations, and regional variation

Abstract Background Urolithiasis (UL) is a common condition that imposes a substantial burden on healthcare systems through frequent emergency department (ED) visits and hospitalizations. In Mexico, previous studies have described the epidemiology of UL; however, nationwide data characterizing emergency care, hospitalizations, and regional patterns of healthcare utilization remain limited. Objective To characterize the magnitude, temporal trends, geographic variation, and contextual patterns of UL-related ED visits and hospitalizations among adults in Mexico. Methods A retrospective observational study was conducted using publicly available databases of ED visits and hospitalizations among adults aged ≥ 18 years between 2020 and 2024. Cases were identified using International Classification of Disease, 10th Revision (ICD-10). Crude utilization rates per 100,000 adults ≥ 18 years were calculated using population estimates from the National Population Council. Negative binomial regression models with population offsets were used to evaluate state-level differences and state-by-year variation in ED and hospitalization utilization. Principal component analysis (PCA) followed by hierarchical clustering was used to explore environmental, social, and epidemiological patterns. Results A total of 164,043 UL-related ED visits and 33,352 hospitalizations were recorded nationwide during the study period. The national crude ED utilization rate was 36.16 per 100,000 adults ≥ 18 years, with the highest rates observed in Tabasco, Campeche, and Durango. The national hospitalization rate was 7.35 per 100,000 adults ≥ 18 years, with the highest rates in Yucatán, Tabasco, and Guerrero. Significant state-by-year interactions were observed for both ED utilization and hospitalizations ( p < 0.001), indicating substantial heterogeneity in temporal changes across states. Exploratory PCA followed by hierarchical clustering identified distinct state-level profiles characterized by combinations of environmental, social, and epidemiological indicators. Conclusions Marked geographic and temporal heterogeneity in UL-related healthcare utilization was observed across Mexico. Tabasco had the highest crude ED utilization rate, whereas Yucatán had the highest hospitalization rate. Environmental conditions, social vulnerability, and healthcare-access factors may contribute to regional variations in UL-related healthcare utilization. Future studies integrating individual-level clinical data with harmonized environmental and socioeconomic information are needed to clarify the factors underlying the observed geographic differences.