Spatial and temporal clustering of calcium oxalate and magnesium ammonium phosphate uroliths in dogs living in Ontario, Canada between 1998 and 2006

Abstract

Using the spatial scan statistic with a Bernoulli model, in a comparison of the two most common canine uroliths, calcium oxalate (CaOx) and magnesium ammonium phosphate (struvite) we determined whether there was evidence of spatial and/or temporal clustering of each urolith type based on canine submissions from Ontario to the Canadian Veterinary Urolith Centre (CVUC) between 1998 and 2006. During this period, there were 10,478 canine submissions, excluding cases that were identified as recurrent. We were able to georeference approximately 93% of these incident cases. After adjusting for spatial and temporal distributions of dogs based on the demographic risk factors of age, sex, and breed-type, statistically significant spatial and temporal clusters were present for both CaOx and struvite urolith types. A purely temporal struvite cluster occurred between February 10, 1998 and December 20, 2001, whereas, a purely temporal CaOx cluster occurred between September 2, 2005 and December 21, 2006. Hypotheses to explain the spatial clustering of uroliths include variation in the spatial distribution of water hardness, diet-type, access to veterinary care, and the use of surgical versus medical therapies to treat these uroliths. Based on the cluster locations, water hardness was unlikely to explain the spatial difference between the two cluster types whereas variables related to human population density were more consistent with our findings; the CaOx cluster occurred in the highest population density area of Ontario, and the struvite cluster occurred in the lowest population density area of southern Ontario. The temporal struvite cluster at the beginning and CaOx cluster at the end of the study period reflect a similar trend away from struvite towards CaOx urolithiasis among both canines and humans in the developed countries of North America and Europe.