Burden of gallstone disease in the United States population: Prepandemic rates and trends

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

Figure 1

Rates with all-listed gallstone disease diagnoses among persons with commercial insurance in the United States, 2007-2020. A: Claims-based prevalence by sex; B: Claims-based prevalence by race-ethnicity; C: Claims-based prevalence by age; D: Total visits; E: Ambulatory care visits by sex; F: Ambulatory care visits by race-ethnicity; G: Ambulatory care visits by age; H: Emergency department visits by sex; I: Emergency department visits by race-ethnicity; J: Emergency department visits by age; K: Inpatient stays by sex; L: Inpatient stays by race-ethnicity; M: Inpatient stays by age. Source: Optum Clinformatics^® Data Mart. ICD: International Classification of Diseases.

Figure 3

Age-adjusted rates with all-listed gallstone disease diagnoses in the United States. A: Total visits; B: Ambulatory care visits by sex; C: Ambulatory care visits by race-ethnicity; D: Ambulatory care visits by age; E: Emergency department visits by sex; F: Emergency department visits by age; G: Hospital discharges by sex; H: Hospital discharges by age; I: Hospital discharges by race-ethnicity; J: Mortality by sex; K: Mortality by race-ethnicity; L: Mortality by age. Source: National Ambulatory Medical Care Survey, 2005-2016 (3-year averages, 2005-2007, 2008-2010, 2011-2013, 2014-2016); Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample, 2006-2020; HCUP National Inpatient Sample, 2006-2020; and Vital Statistics of the United States, 2006-2020. ICD: International Classification of Diseases.

Figure 2

Rates with all-listed gallstone disease diagnoses among age-eligible fee-for-service and Advantage Medicare beneficiaries in the United States, 2006-2020. A: Claims-based prevalence by sex; B: Claims-based prevalence by race; C: Total visits; D: Ambulatory care visits by sex; E: Ambulatory care visits by race; F: Emergency department visits by sex; G: Emergency department visits by race; H: Inpatient stays by sex; I: Inpatient stays by race; J: Mortality by sex; K: Mortality by race. Source: Medicare 5% file. ICD: International Classification of Diseases.

Figure 4

Cholecystectomy rates in the United States. A: National total cholecystectomies; B: National hospital cholecystectomy by sex; C: National hospital cholecystectomy by race-ethnicity; D: National hospital cholecystectomy by age; E: Optum total cholecystectomies; F: Optum ambulatory laparoscopic cholecystectomy by sex; G: Optum ambulatory laparoscopic cholecystectomy by race-ethnicity; H: Optum ambulatory laparoscopic cholecystectomy by age; I: Optum hospital cholecystectomy by sex; J: Optum hospital cholecystectomy by race-ethnicity; K: Optum hospital cholecystectomy by age; L: Medicare total cholecystectomies; M: Medicare ambulatory laparoscopic cholecystectomy by sex; N: Medicare ambulatory laparoscopic cholecystectomy by race; O: Medicare hospital cholecystectomy by sex; P: Medicare hospital cholecystectomy by race. Source: Healthcare Cost and Utilization Project (HCUP) Nationwide Ambulatory Surgery Sample, 2016-2020; HCUP National Inpatient Sample, 2006-2020; Optum Clinformatics^® Data Mart, 2007-2020; Medicare 5% file, 2006-2020.