Gastroenterology
Volume 140, Issue 2 , Pages 508-516, February 2011

Gallstone Disease Is Associated With Increased Mortality in the United States

  • Constance E. Ruhl

      Affiliations

    • Social and Scientific Systems, Inc, Silver Spring, Maryland
    • Corresponding Author InformationReprint requests Address requests for reprints to: Constance E. Ruhl, MD, PhD, Social & Scientific Systems, Inc, 8757 Georgia Avenue, 12th Floor, Silver Spring, Maryland 20910. fax: (301) 628-3201
    • ,
  • James E. Everhart

      Affiliations

    • National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland

Received 27 July 2010; accepted 30 October 2010. published online 15 November 2010.

Background & Aims

Gallstones are common and contribute to morbidity and health care costs, but their effects on mortality are unclear. We examined whether gallstone disease was associated with overall and cause-specific mortalities in a prospective national population-based sample.

Methods

We analyzed data from 14,228 participants in the third US National Health and Nutrition Examination Survey (20–74 years old) who underwent gallbladder ultrasonography from 1988 to 1994. Gallstone disease was defined as ultrasound-documented gallstones or evidence of cholecystectomy. The underlying cause of death was identified from death certificates collected through 2006 (mean follow-up, 14.3 years). Mortality hazard ratios (HR) were calculated using Cox proportional hazards regression analysis to adjust for multiple demographic and cardiovascular disease risk factors.

Results

The prevalence of gallstones was 7.1% and of cholecystectomy was 5.3%. During a follow-up period of 18 years or more, the cumulative mortality was 16.5% from all causes (2389 deaths), 6.7% from cardiovascular disease (886 deaths), and 4.9% from cancer (651 deaths). Participants with gallstone disease had higher all-cause mortality in age-adjusted (HR = 1.3; 95% confidence interval [CI]: 1.2–1.5) and multivariate-adjusted analysis (HR = 1.3; 95% CI: 1.1–1.5). A similar increase was observed for cardiovascular disease mortality (multivariate-adjusted HR = 1.4; 95% CI: 1.2–1.7), and cancer mortality (multivariate-adjusted HR = 1.3; 95% CI: 0.98–1.8). Individuals with gallstones had a similar increase in risk of death as those with cholecystectomy (multivariate-adjusted HR = 1.1; 95% CI: 0.92–1.4).

Conclusions

In the US population, persons with gallstone disease have increased mortality overall and mortalities from cardiovascular disease and cancer. This relationship was found for both ultrasound-diagnosed gallstones and cholecystectomy.

Keywords:  Gallstone Disease , Epidemiology , Gallbladder , Cholelithiasis

Abbreviations used in this paper:  CI, confidence ratio , GGT, γ-glutamyltransferase , HR, hazard ratio , ICD, International Classification of Diseases , NHANES, National Health and Nutrition Examination Survey

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 Conflicts of interest The authors disclose no conflicts.

 Funding This work was supported by a contract from the National Institute of Diabetes and Digestive and Kidney Diseases (HHSN267200700001G).

PII: S0016-5085(10)01611-2

doi:10.1053/j.gastro.2010.10.060

Gastroenterology
Volume 140, Issue 2 , Pages 508-516, February 2011

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