Gastroenterology

Gastroenterology

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

Clinical—Liver, Pancreas, and Biliary Tract
Gallstone Disease Is Associated With Increased Mortality in the United States

https://doi.org/10.1053/j.gastro.2010.10.060Get rights and content

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.

Section snippets

Methods

NHANES III was conducted in the United States from 1988 through 1994 by the National Center for Health Statistics of the Centers for Disease Control and Prevention.9 It consisted of a cross-sectional interview, examination, and laboratory data collected from a complex multistage, stratified, clustered probability sample representative of the civilian, noninstitutionalized population with oversampling of persons aged 60 years and older, African Americans, and Hispanics. The survey was approved

Results

The prevalence (±SE) of gallstones was 7.1% (±0.38%) and cholecystectomy 5.3% (±0.29%). Because participants with gallstone disease tended to be considerably older than those without (mean, 53.2 years vs 40.7 years; P < .001), other baseline characteristics were compared, adjusted for age (Table 1). In contrast to participants without gallstone disease, those with gallstone disease were more likely to be female, Mexican-American, diabetic, less educated and less physically active, have a higher

Discussion

The main finding of this study was an association of gallstone disease with overall, cardiovascular disease, and cancer mortality in a large, national, population-based, prospective study. For overall and cardiovascular disease mortality, this was a consistent finding in both age-adjusted and multivariate-adjusted analyses. For cancer mortality, the strength of the relationship was unchanged but did not reach statistical significance in multivariate-adjusted analysis. Similar to our results, a

Acknowledgments

The National Center for Health Statistics (NCHS) was the source for the National Health and Nutrition Examination Survey III Linked Mortality Files. All analyses, interpretations, and conclusions are those of the authors and not NCHS. The authors thank Negasi Beyene for assistance in using the NCHS Research Data Center, Tempie Shearon, Lead Research Area Specialist, Kidney Epidemiology and Cost Center, University of Michigan for assistance with programming for creation of the survival curve

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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).

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