Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2024; 16(4): 1130-1148
Published online Apr 27, 2024. doi: 10.4240/wjgs.v16.i4.1130
Burden of gallstone disease in the United States population: Prepandemic rates and trends
Aynur Unalp-Arida, Constance E Ruhl
Aynur Unalp-Arida, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-5458, United States
Constance E Ruhl, Social & Scientific Systems, Inc., DLH Holdings Corp Company, Silver Spring, MD 20910, United States
Author contributions: Unalp-Arida A and Ruhl CE conceived and designed the study and analyzed and interpreted the data; Ruhl CE drafted the manuscript; Unalp-Arida A critically revised the manuscript for important intellectual content; both authors have read and approved the final manuscript.
Institutional review board statement: The study used only secondary de-identified data. Because there were no experimental protocols including human subjects, our study does not qualify as human subjects research. Consequently, there were no institutional approval requirements.
Informed consent statement: The study used only secondary de-identified data. Because there were no experimental protocols including human subjects, our study does not qualify as human subjects research. Consequently, there were no individual patient consent requirements.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Vital Statistics of the United States data are publicly available at https://www.nber.org/research/data/mortality-data-vital-statistics-nchs-multiple-cause-death-data. The National Ambulatory Medical Care Survey data are available at https://www.cdc.gov/nchs/ahcd/index.htm. Restricted data are available through the National Center for Health Statistics Research Data Center (http://www.cdc.gov/rdc). Healthcare Cost and Utilization Project National Inpatient Sample, Nationwide Emergency Department Sample, and Nationwide Ambulatory Surgery Sample data were purchased from the Agency for Healthcare Research and Quality with a data use agreement and cannot be made available to other researchers (https://hcup-us.ahrq.gov/). The Medicare 5% Sample and Medicaid data were used through a data use agreement with the Centers for Medicare and Medicaid Services and cannot be made available to other researchers (https://resdac.org/). Optum Clinformatics® Data Mart data were used through a contract between the National Institute of Diabetes and Digestive and Kidney Diseases and Optum and a third-party agreement with DLH. Optum electronic health records are proprietary and cannot be made available to other researchers. https://www.optum.com/content/dam/optum/resources/productSheets/Clinformatics_for_Data_Mart.pdf.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Constance E Ruhl, MD, PhD, Senior Researcher, Social & Scientific Systems, Inc., DLH Holdings Corp Company, 8757 Georgia Avenue, 12th Floor, Silver Spring, MD 20910, United States. constance.ruhl@dlhcorp.com
Received: November 14, 2023
Peer-review started: November 14, 2023
First decision: January 5, 2024
Revised: January 23, 2024
Accepted: March 20, 2024
Article in press: March 20, 2024
Published online: April 27, 2024
Processing time: 160 Days and 9.1 Hours
Abstract
BACKGROUND

Gallstone disease is one of the most common digestive disorders in the United States and leads to significant morbidity, mortality, and health care utilization.

AIM

To expand on earlier findings and investigate prepandemic rates and trends in the gallstone disease burden in the United States using national survey and claims databases.

METHODS

The National Ambulatory Medical Care Survey, National Inpatient Sample, Nationwide Emergency Department Sample, Nationwide Ambulatory Surgery Sample, Vital Statistics of the United States, Optum Clinformatics® Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample and Medicaid files 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 100000 population.

RESULTS

Gallstone disease prevalence (claims-based, 2019) was 0.70% among commercial insurance enrollees, 1.03% among Medicaid beneficiaries, and 2.09% among Medicare beneficiaries and rose over the previous decade. Recently, in the United States population, gallstone disease contributed to approximately 2.2 million ambulatory care visits, 1.2 million emergency department visits, 625000 hospital discharges, and 2000 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 United States included 605000 ambulatory laparoscopic, 280000 inpatient laparoscopic, and 49000 inpatient open procedures annually. Among commercial insurance enrollees, rates were higher compared with national data for laparoscopic procedures.

CONCLUSION

The 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.

Keywords: Gallstone disease; Burden; Cholecystectomy; Mortality; Health care use; Cholelithiasis; Gallstones; Epidemiology

Core Tip: We used national survey and claims databases to investigate prepandemic rates and trends in the United States gallstone disease burden. Gallstone disease prevalence (claims-based, 2019) ranged from 0.70% to 2.09% and rose over a decade. Gallstone disease contributed to approximately 2.2 million ambulatory care visits, 1.2 million emergency department visits, 625000 hospital discharges, and 2000 deaths annually. Medical care was higher among women, Hispanics, and older adults and lower among Blacks. Ambulatory care and emergency department visit rates with gallstone disease rose while hospital discharge and mortality rates declined. Cholecystectomies performed included 605000 ambulatory laparoscopic, 280000 inpatient laparoscopic, and 49000 inpatient open procedures annually.