title: [Gallbladder cancer: trend and risk distribution in Chile].
abstract: BACKGROUND
  Gallbladder cancer (GBC) is the first cause of death by cancer among Chilean women and mortality has not improved in the last 20 years.
  
  
  OBJECTIVE
  To study GBC mortality trend from 1985-2002, analyze risk differentials by age, sex, geographic region and accessibility to surgery.
  
  
  METHODS
  Mortality data was obtained from death certificate databases. Population data was obtained from the census and biliary surgery information, from Ministry of Health registries. Standardized Mortality rates were based in the world population; trend was analyzed with point of change methods.
  
  
  RESULTS
  From 1985 to 2002, 27,183 GBC deaths occurred, 1,510 per year. The absolute number of deaths increased in 65% but standardized mortality rates remained unchanged at 11.3 per 100,000. These were higher among women than men (15.6 and 7.0, respectively, with a risk ratio of 2.2). Sex ratio peaked at ages 35-54 with risk ratio of 4.1. Death risk increased from North to South, peaking in poorer areas, especially in places with rural population and Mapuche ethnic admixture. Mortality appear to correlate with the rate of people waiting for gallbladder surgery, but not reaching statistical significance (r(2) 0.27, ns). Compared with other countries, Chile has a higher rate of GBC deaths in relation to its gross domestic product per capita.
  
  
  CONCLUSIONS
  There is a high and persistent persistent risk for GBC in Chile, particularly among women, from the Southern regions where gallbladder surgery is insufficient for the needs, as reflected by the rates of people waiting for biliary surgery. GBC rates could be dropped by offering gallbladder surgery to everyone waiting for it and to those incident cases with gallstones.
authors.affiliation: Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Andia K
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gederlini G
authors.forename: Catterina
authors.initials: C
authors.lastname: Ferreccio R
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002277:Carcinoma / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D002677:Chile / Q000453:epidemiology; D002763:Cholecystectomy / Q000191:economics / Q000706:statistics & numerical data; D003644:Death Certificates; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D017678:Sex Distribution