Global, regional, and national burden of gallbladder and biliary diseases in 204 countries and territories, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.
Abstract
Background
Gallbladder and biliary diseases-including cholelithiasis, cholecystitis, cholangitis, and other non-malignant biliary tract disorders-are important contributors to the global digestive disease burden, but a global, comprehensive, and systematic estimation of their burden is absent. We aimed to quantify long-term trends and current patterns in prevalence, mortality, and disability associated with gallbladder and biliary diseases across geographies, sexes, and ages.
Methods
We used estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to assess the burden of gallbladder and biliary diseases in 204 countries and territories from 1990 to 2023. Mortality was modelled with the Cause of Death Ensemble model and prevalence with the Disease Modelling Meta-Regression tool (DisMod-MR 2.1). Years of life lost (YLLs) were calculated as the number of deaths for each age-sex-location-year multiplied by the standard life expectancy at each age. Severity-specific prevalence values were multiplied by their respective disability weights (with asymptomatic cases assigned zero disability) to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were computed by summing YLDs and YLLs. We report prevalence, mortality, YLDs, YLLs, and DALYs as counts and age-standardised and age-specific rates per 100 000 population with 95% uncertainty intervals (UIs), stratified by sex, GBD region, and Socio-demographic Index (SDI).
Findings
In 1990 and 2023, the global counts for prevalence attributable to gallbladder and biliary diseases were 157·4 million (95% UI 134·0 to 183·3) and 264·4 million (226·0 to 309·9), for deaths were 65 800 (95% UI 53 000 to 78 800) and 146 700 (121 800 to 171 300), and for DALYs were 4·8 million (95% UI 3·5 to 6·2) and 8·2 million (6·3 to 10·6), representing substantial increases. However, age-standardised rates declined over the same period, from 3573·2 (95% UI 3045·5 to 4159·1) per 100 000 population to 2990·1 (2561·5 to 3492·5) per 100 000 population for prevalence, from 1·95 (1·58 to 2·31) per 100 000 population to 1·67 (1·39 to 1·95) per 100 000 population for mortality, and from 111·5 (84·1 to 143·3) per 100 000 population to 92·3 (70·9 to 119·6) per 100 000 population for DALYs. Over the past three decades, females had higher age-standardised prevalence and DALY rates than males, while sex differences in mortality rates were smaller. In 2023, age-standardised prevalence and DALY rates were lowest in south Asia and highest in central and western Europe, central Asia, and many regions in Latin America. By contrast, several regions in sub-Saharan Africa had relatively low prevalence and DALY rates but comparatively high mortality rates. National patterns broadly mirrored these regional profiles. In 2023, prevalence and DALY counts peaked in middle to early-older adulthood (ages 55-69 years), but age-specific rates continued to rise into the oldest age groups, with DALYs dominated by YLDs in midlife and early-older adulthood and by YLLs at older ages (≥80 years). The number of deaths peaked in the ninth decade of life, but age-specific rates also peaked in the oldest age groups. Across GBD regions, the association between SDI and age-standardised prevalence and DALY rates generally followed a reversed U-shaped pattern, with the lowest rates at low SDI, peak rates at intermediate SDI, and declining rates at the highest SDI levels. The association between SDI and mortality rate was less clear.
Interpretation
The global burden of gallbladder and biliary diseases is rising in absolute terms despite declining age-standardised rates, underscoring the importance of population growth and ageing. Health systems, particularly in settings with rapidly ageing populations and intermediate SDI levels, will need to expand diagnostic, elective, and emergency surgical capacity while investing in prevention of obesity and metabolic risk factors. Marked regional and national heterogeneity, as well as differences in risk factors, might reflect variance in health-system capacity and access to care, including timely diagnosis, availability of surgical services, and perioperative care. The predominance of non-fatal disability in midlife and rising mortality in older age groups indicates that integrated strategies spanning risk-factor control, early diagnosis, elective management, and robust acute care for older adults are essential to reduce both YLDs and YLLs.
Funding
Gates Foundation.