title: Nationwide epidemiological study of severe gallstone disease in Taiwan.
abstract: BACKGROUND
  Our study aimed to assess the nationwide trends in the incidence of severe gallstone disease in Taiwan among adults aged >or=20.
  
  
  METHODS
  A retrospective longitudinal study was conducted using Taiwan National Health Insurance Research Database collected during 1997-2005. Patients with incident severe gallstone disease (acute cholecystitis, biliary pancreatitis, acute cholangitis) and gallstone-related procedures (elective and non-elective cholecystectomy, endoscopic retrograde cholangiopancreatography [ERCP]) that led to hospital admission were identified using ICD-9-CM diagnostic and procedure codes. Annual incidence rates of gallstone-related complications and procedures were calculated and their 95% confidence intervals (CI) were estimated assuming a Poisson distribution.
  
  
  RESULTS
  The hospital admission rate for severe gallstone disease increased with advancing age and the age-standardized rate (95% CI) per 1000 population was 0.60 (0.59-0.60) for men and 0.59 (0.59-0.60) for women. Men had a higher rate of acute cholecystitis, probably due to the substantially lower rate of elective cholecystectomy among men than women. For those aged 20-39, hospital admissions for all gallstone-related complications and procedures increased significantly. For those aged >or=60, incidences of biliary pancreatitis, acute cholangitis, and hospital admission for gallstone receiving ERCP increased significantly without substantial change in the incidence of acute cholecystitis and despite a decreased rate of elective cholecystectomy.
  
  
  CONCLUSIONS
  This population-based study found a substantial increase in the rate of admission for severe gallstone disease among those aged 20-39. Concurrently, the incidences of biliary pancreatitis and acute cholangitis have risen among those aged >or=60.
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China. docjohn@ntuh.gov.tw
authors.forename: John
authors.initials: J
authors.lastname: Huang
authors.forename: Chia-Hsuin
authors.initials: CH
authors.lastname: Chang
authors.forename: Juin-Ling
authors.initials: JL
authors.lastname: Wang
authors.forename: Hsu-Ko
authors.initials: HK
authors.lastname: Kuo
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Shau
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002761:Cholangitis / Q000453:epidemiology; D041881:Cholecystitis, Acute / Q000453:epidemiology; D005260:Female; D042882:Gallstones / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology
references.citation: Adv Data. 2007 Jul 12;(385):1-19
references.pmid: 17691217
references.citation: Pancreas. 2006 Nov;33(4):323-30
references.pmid: 17079934
references.citation: N Engl J Med. 1994 Feb 10;330(6):403-8
references.pmid: 8284007
references.citation: World J Gastroenterol. 2006 Feb 28;12(8):1281-6
references.pmid: 16534886
references.citation: Hepatogastroenterology. 2004 Sep-Oct;51(59):1271-4
references.pmid: 15362730
references.citation: BMJ. 2001 Jan 13;322(7278):91-94
references.pmid: 11154626
references.citation: Lancet. 1973 Aug 4;2(7823):249-51
references.pmid: 4124435
references.citation: Best Pract Res Clin Gastroenterol. 2006;20(6):1075-83
references.pmid: 17127189
references.citation: Age Ageing. 1998 Jul;27(4):437-41
references.pmid: 9883999
references.citation: South Med J. 2002 Dec;95(12):1419-23
references.pmid: 12597310
references.citation: Dig Dis Sci. 1995 Sep;40(9):1963-73
references.pmid: 7555451
references.citation: Ann Surg. 2008 Jan;247(1):95-103
references.pmid: 18156928
references.citation: Vital Health Stat 13. 1998 Nov;(139):1-119
references.pmid: 9866429
references.citation: Br Med J. 1972 Sep 16;3(5828):672-5
references.pmid: 4650846
references.citation: Am J Gastroenterol. 2004 Jul;99(7):1364-70
references.pmid: 15233680
references.citation: Am J Gastroenterol. 1998 Sep;93(9):1405-7
references.pmid: 9732915
references.citation: Dig Dis Sci. 1999 Aug;44(8):1674-83
references.pmid: 10492152
references.citation: Hepatology. 2005 Apr;41(4):738-46
references.pmid: 15793851
references.citation: N Engl J Med. 1999 Sep 9;341(11):777-84
references.pmid: 10477775
references.citation: Lancet. 1990 Jan 6;335(8680):21-2
references.pmid: 1967332
references.citation: J Clin Gastroenterol. 1990 Oct;12(5):542-6
references.pmid: 2229997
references.citation: Postgrad Med J. 2000 Nov;76(901):700-3
references.pmid: 11060144
references.citation: Am J Clin Nutr. 2004 Jul;80(1):38-44
references.pmid: 15213025
references.citation: Postgrad Med. 2000 Sep 1;108(3):143-6, 149-53
references.pmid: 11004941
references.citation: World J Surg. 2004 Feb;28(2):206-10
references.pmid: 14708060
references.citation: Aliment Pharmacol Ther. 2003 Feb 15;17(4):561-9
references.pmid: 12622765
references.citation: Am J Surg. 1993 Apr;165(4):390-8
references.pmid: 8480870
references.citation: Ann Intern Med. 1998 Mar 15;128(6):417-25
references.pmid: 9499324
references.citation: Ann Intern Med. 2008 Feb 19;148(4):258-67
references.pmid: 18283203
references.citation: Am J Med. 2006 Sep;119(9):760-7
references.pmid: 16945611
references.citation: Dig Dis Sci. 1992 May;37(5):764-8
references.pmid: 1563321
references.citation: Hepatogastroenterology. 1999 May-Jun;46(27):1607-12
references.pmid: 10430304
references.citation: Br J Surg. 1999 Apr;86(4):465-70
references.pmid: 10215815
references.citation: Am Fam Physician. 2000 Mar 15;61(6):1673-80, 1687-8
references.pmid: 10750875
references.citation: J Gastroenterol Hepatol. 2006 Nov;21(11):1737-43
references.pmid: 16984599
references.citation: CMAJ. 2005 Apr 12;172(8):1015-9
references.pmid: 15824406
references.citation: CMAJ. 2000 May 16;162(10):1421-4
references.pmid: 10834045
references.citation: Gastroenterology. 2005 Jul;129(1):105-12
references.pmid: 16012940
references.citation: Best Pract Res Clin Gastroenterol. 2006;20(6):981-96
references.pmid: 17127183
references.citation: Am J Gastroenterol. 2005 Nov;100(11):2540-50
references.pmid: 16279912