Water hardness and urinary stone disease.

On the macrogeographic scale, a strong negative association exists in the United States between water hardness and urinary stone disease. This investigation studies the association on the microgeographical scale, where it is possible to control for confounding environmental factors. The study was conducted on 2,295 patients from 2 regions: the Carolinas which had soft water and high stone incidence, and the Rockies which had hard water and low stone incidence. Home tap water samples from urinary stone patient hospitalizations were compared with that of controls, concurrent inguinal hernia patient hospitalization. After adjusting for environmental factors, no significant difference (p = 0.59) between the 2 groups was obtained in tap water calcium, magnesium, and sodium concentrations. An incidental but potentially important finding was that those consuming water from a private well had an estimated relative risk of 1.5 (p less than 0.01) compared to those using public water. While no cause-effect relationship is suggested, stone-formers might consider avoiding private well water. On the other hand, water hardness should be a minor concern with respect to stone formation.