Background and rationale. Gallstone disease is one of the most common digestive disorders in the United States and leads to significant morbidity, mortality, and health care utilization. We used national survey and claims databases to expand on earlier findings and investigate current trends in the gallstone disease burden in the United States. Methods. The National Ambulatory Medical Care Survey, National Inpatient Sample, Nationwide Emergency Department Sample, Nationwide Ambulatory Surgery Sample, Vital Statistics of the U.S., Optum Clinformatics Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample databases 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 100,000 population. Results. Gallstone disease prevalence (claims-based, 2019) was 0.70% among commercial insurance enrollees and 1.65% among Medicare beneficiaries and rose over the previous decade in both groups. Recently, in the U.S. population, gallstone disease contributed to approximately 2.2 million ambulatory care visits, 1.1 million emergency department visits, 615,000 hospital discharges, and 2,000 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 U.S. included 558,000 ambulatory laparoscopic, 285,000 inpatient laparoscopic, and 50,000 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.

The authors have declared no competing interest.

The work was supported by contracts from the National Institute of Diabetes and Digestive and Kidney Diseases (HHSN275201700074U and 75N94022F00050).

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The National Ambulatory Medical Care Survey was approved by the Centers for Disease Control and Prevention ethics review board. Healthcare Cost and Utilization Project (HCUP) data sources were used in accordance with HCUP data use agreements. The New England Independent Review Board (NEIRB) determined our use of CMS Medicare data was exempt as existing data from which subjects cannot be identified. The Optum claims data are certified as de-identified by an independent statistical expert following Health Insurance Portability and Accountability Act (HIPAA) statistical de-identification rules, and managed according to Optum customer data use agreements. The Vital Statistics of the U.S. Multiple Cause-of-death data are publicly available.

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