The Burden of Gallstone Disease in the United States Population

Background and rationaleGallstone disease is one of the most common digestive disorders in the United States and leads to significant morbidity, mortality, and health care utilization. We used national survey and claims databases to expand on earlier findings and investigate current trends in the gallstone disease burden in the United States. MethodsThe National Ambulatory Medical Care Survey, National Inpatient Sample, Nationwide Emergency Department Sample, Nationwide Ambulatory Surgery Sample, Vital Statistics of the U.S., Optum Clinformatics(R) Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample databases were used to estimate claims-based prevalence, medical care including cholecystectomy, and mortality with a primary or other gallstone diagnosis. Rates were age-adjusted (for national databases) and shown per 100,000 population. ResultsGallstone disease prevalence (claims-based, 2019) was 0.72% among commercial insurance enrollees and 2.09% among Medicare beneficiaries and rose over the previous decade in both groups. Recently, in the U.S. population, gallstone disease contributed to approximately 2.2 million ambulatory care visits, 1.2 million emergency department visits, 625,000 hospital discharges, and 2,000 deaths annually. Women had higher medical care rates with a gallstone disease diagnosis, but mortality rates were higher among men. Hispanics had higher ambulatory care visit and hospital discharge rates compared with Whites, but not mortality rates. Blacks had lower ambulatory care visit and mortality rates, but similar hospital discharge rates compared with whites. During the study period, ambulatory care and emergency department visit rates with a gallstone disease diagnosis rose, while hospital discharge and mortality rates declined. Among commercial insurance enrollees, rates were higher compared with national data for ambulatory care visits and hospitalizations, but lower for emergency department visits. Cholecystectomies performed in the U.S. included 605,000 ambulatory laparoscopic, 280,000 inpatient laparoscopic, and 49,000 inpatient open procedures annually. Among commercial insurance enrollees, rates were higher compared with national data for laparoscopic procedures ConclusionThe gallstone disease burden in the United States is substantial and increasing, particularly among women, Hispanics, and older adults with laparoscopic cholecystectomy as the mainstay treatment. Current practice patterns should be monitored for better health care access.