The incidence of urolithiasis among commercial aviation pilots

Purpose: A kidney stone event in a commercial aviation pilot has significant vocational implications since the Federal Aviation Administration specifically prohibits medical certification in the setting of recent or recurrent stone disease. Given these serious concerns, an understanding of the burden of stone disease on the commercial aviation community is important. Thus, we performed a study in partnership with the Federal Aviation Administration to better characterize the epidemiology of this condition. Materials and Methods: We reviewed the Federal Aviation Administration Aerospace Medical Certification database for 2000 through 2007. Pilots with a class I certificate (scheduled commercial aviation) were selected for further review. All medical certificates submitted with a pathology code of 573 (urolithiasis) were identified for analysis. Results: From 2000 through 2007 between 3.7% and 4.6% of scheduled commercial aviation pilots were diagnosed with urolithiasis. However, during the study period there was a significant decrease in the proportion of pilots diagnosed with urolithiasis. Conclusions: A meaningful number of commercial aviation pilots are affected by urolithiasis each year. Our analysis detected a significant decrease in the proportion of affected pilots, although the reason for this trend is not well understood. It may be that changes in the occupational environment that could affect risk factors for stone formation are responsible. Further efforts to characterize stone risk in this unique population are welcome, given the larger vocational and societal consequences of a stone event in the setting of airline transport.