Chapter 22: Gallstones

The Burden of Digestive Diseases in the United States

James E. Everhart, M.D., M.P.H.

Gallstones (cholelithiasis) are coded with or without complications (choledocholithiasis, cholangitis, cholecystitis). Cholecystitis (inflammation of the gallbladder) without the presence of gallstones was not included (Appendix 1).

In 2004, there were an estimated 1.8 million ambulatory care visits with a diagnosis of gallstones, most of which were for gallstones as a first-listed diagnosis (Table 1). Visit rates increased with age, although only modestly after age 65 years. Age-adjusted rates for any visits were 18 percent higher among whites than blacks and 162 percent higher for females than males, which is in keeping with the known risks for gallstones. Gallstones ranked fifth among digestive diseases in all-listed discharge diagnoses in 2004. However, this was an underestimate of the actual hospital burden, because most hospitalizations with gallstones were for cholecystectomy, of which a high proportion were performed laparoscopically without overnight stay and, therefore, not included in hospitalization statistics.22 Based on hospitalization rates prior to this shift in hospital care, gallstones would have ranked first among digestive diseases in first-listed diagnoses and second in all-listed (the first being GERD). Hospitalization rates with mention of gallstones increased with age, were similar for blacks and whites, and were 58 percent higher for women than men. Over time, rates of ambulatory care visits were relatively stable (Figure 1), but increased from the 1980s by at least 20 percent.23 Hospitalization rates dropped by 40 percent in 2004 from their peak in 1991, because of the aforementioned change in hospital care.

Case-fatality rates for gallstones were low in 2004, but there were still more than 1,000 deaths with gallstones listed as underlying cause (Table 2), because the condition is so common and complications can be severe. The large majority of deaths occurred among persons age 65 years and older. Thus, there were only about 4 Y YPLL prior to age 75 years per death with gallstones as the underlying cause. Age-adjusted death rates differed little by race and by sex. Mortality rates fell between 1979 and 2004 by 56 percent for gallstones as underlying cause and by 71 percent as underlying or other cause (Figure 2). This was the greatest rate of decline for any common digestive disease, continuing a pattern from at least 1950, when more than 5,000 persons had gallstones listed as underlying cause of death.24

According to the Verispan database of retail pharmacy prescriptions (Appendix 2), in 2004, the total number of prescriptions for gallstones was 1.65 million at a retail cost of $18.6 million. Analgesics constituted more than 99 percent of these prescriptions.

References

Table 1. Gallstones: Number and Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With First-Listed and All-Listed Diagnoses by Age, Race, and Sex in the United States, 2004

Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (3-year average, 2003–2005), and Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS)

Demographic Characteristics Ambulatory Care Visits First-Listed Diagnosis Number in Thousands Ambulatory Care Visits First-Listed Diagnosis Rate per 100,000 Ambulatory Care Visits All-Listed Diagnosis Number in Thousands Ambulatory Care Visits All-Listed Diagnosis Rate per 100,000 Hospital Discharges First-Listed Diagnosis Number in Thousands Hospital Discharges First-Listed Diagnosis Rate per 100,000 Hospital Discharges All-Listed Diagnosis Number in Thousands Hospital Discharges All-Listed Diagnosis Rate per 100,000
AGE (Years)
Under 15
2 4 4 6
AGE (Years)
15–44
443 352 651 518 119 95 179 142
AGE (Years)
45–64
522 739 734 1,039 106 150 180 255
AGE (Years)
65+
321 883 411 1,132 124 341 259 713
Race
White
1,041 421 1,516 615 278 112 490 195
Race
Black
127 369 179 521 34 102 63 198
Sex
Female
932 604 1,358 882 235 151 406 256
Sex
Male
367 260 478 336 114 85 214 162
Total 1,299 442 1,836 625 352 120 622 212

Figure 1. Gallstones: Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With All–Listed Diagnoses in the United States, 1979–2004

The rate of ambulatory care visits over time (age-adjusted to the 2000 U.S. population) is shown by 3-year periods (except for the first period which is 2 years), between 1992 and 2005 (beginning with 1992–1993 and ending with 2003–2005). Ambulatory care visits per 100,000 were relatively stable from 1992-1993 when they were 675 through 2003-2005 when they were 614. The hospitalization rate per 100,000 was 307 in 1979 and was relatively stable through 1991, after which it dropped to 189 in 2004.
Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (averages 1992–1993, 1994–1996, 1997–1999, 2000–2002, 2003–2005), and National Hospital Discharge Survey (NHDS)

Table 2. Gallstones: Number and Age-Adjusted Rates of Deaths and Years of Potential Life Lost (to Age 75) by Age, Race, and Sex in the United States, 2004

Source: Vital Statistics of the United States

Demographic Characteristics Underlying Cause Number of Deaths Underlying Cause Rate per 100,000 Underlying Cause Years of Potential Life Lost in Thousands Underlying or Other Cause Number of Deaths Underlying or Other Cause Rate per 100,000
AGE (Years)
Under 15
1 0.0
AGE (Years)
15–44
31 0.0 1.1 75 0.1
AGE (Years)
45–64
137 0.2 2.6 276 0.4
AGE (Years)
65+
924 2.5 0.6 1,803 5.0
Race
White
960 0.4 3.3 1,883 0.7
Race
Black
90 0.3 0.7 199 0.8
Sex
Female
648 0.3 2.0 1,256 0.7
Sex
Male
444 0.4 2.4 899 0.8
Total 1,092 0.4 4.4 2,155 0.7

Figure 2. Gallstones: Age-Adjusted Rates of Death in the United States, 1979–2004

Mortality rates fell between 1979 and 2004, more sharply for underlying or other causes than for underlying cause alone. Underlying-cause mortality per 100,000 declined from 0.82 in 1979 to 0.36 in 2004. All-cause mortality per 100,000 declined from 2.45 in 1979 to 0.71 in 2004.
Source: Vital Statistics of the United States
Last Reviewed January 2008