Epidemiology of Gallstones
Section snippets
Burden of gallstone disease
Gallstones are an ancient entity, having occurred more than 3500 years ago according to autopsies performed on Egyptian and Chinese mummies. Gallbladder disease today is a common problem: 20 to 25 million Americans harbor gallstones, representing 10% to 15% of the adult population.1 It constitutes a major health burden, with direct plus indirect costs of approximately $6.2 billion annually in the United States.4 This burden has increased more than 20% since the 1980s and accounts for an
Ethnicity and gallstone disease
The highest prevalence of gallstone disease has been described in North American Indians: 64.1% of women and 29.5% of men have gallstones (Table 1).1, 12 This apparent epidemic reaches a high of 73% in Pima Indian women over age 30.13 Similar high occurrences have been reported among the aboriginal populations of South America.14 In the native Mapuche of Chile, gallstone disease afflicts 49.4% of women and 12.6% of men, exceeding 60% in women in their 50s. Mexican Americans are also at an
Risk factors for gallstone formation
Gallstone formation is multifactorial, including constitutional and environmental factors. Some factors, such as diet, activity, rapid weight loss, and obesity, are modifiable, whereas others (eg, age, female gender, genetics, and ethnicity) cannot change. Several case-control studies, which compare those with gallstones versus those without, have identified important associations for harboring gallstones (Table 3).1
The future
The true frequency of gallstone disease at any point in time (ie, prevalence) has advanced with the use of ultrasonographic surveys as opposed to clinical and necropsy studies. These studies have better defined important risk factors and ethnic differences. Cholelithiasis is rampant in American Indians and Hispanics, fostering the concept of a genetic basis for the racial differences. There is also an increased heritability in those who develop cholelithiasis early in life. The complicated
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