背景:胆结石病是美国最常见的消化系统疾病之一,可导致严重的发病率,死亡率,和医疗保健利用。
目的:使用国家调查和索赔数据库,扩大早期发现并调查美国胆结石疾病负担的前流行率和趋势。
方法:全国门诊医疗调查,全国住院患者样本,全国急诊科样本,全国门诊手术样本,美国的生命统计,OptumClinformatics®DataMart,医疗保险和医疗补助服务中心使用医疗保险5%样本和医疗补助文件来估计基于索赔的患病率,包括胆囊切除术在内的医疗护理,和死亡率与原发性或其他胆结石诊断。比率是按年龄调整的(针对国家数据库),并显示为每100000人口。
结果:胆结石病患病率(基于索赔,2019年)在商业保险参保人中为0.70%,1.03%的医疗补助受益人,医疗保险受益人中的2.09%,在过去十年中有所上升。最近,在美国人口中,胆结石疾病促成了大约220万次动态护理就诊,120万急诊就诊,625000医院出院,每年有2000人死亡。女性胆结石疾病诊断的医疗护理率较高,但男性死亡率较高。与白人相比,西班牙裔美国人的门诊就诊和出院率更高,但不是死亡率。黑人的门诊就诊和死亡率较低,但与白人相似的出院率。在学习期间,有胆结石疾病诊断的门诊护理和急诊科就诊率上升,而出院和死亡率下降。在商业保险参保人员中,与全国门诊就诊和住院数据相比,发病率更高,但急诊室就诊的比例较低。在美国进行的胆囊切除术包括605000动态腹腔镜,280000例住院腹腔镜,和每年49000例住院开放程序。在商业保险参保人员中,与腹腔镜手术的国家数据相比,比率更高。
结论:美国的胆结石疾病负担巨大且不断增加,尤其是在女性中,西班牙裔,以腹腔镜胆囊切除术为主要治疗手段的老年人。应监测当前的实践模式,以更好地获得医疗保健。
BACKGROUND: Gallstone disease is one of the most common digestive disorders in the United States and leads to significant morbidity, mortality, and health care utilization.
OBJECTIVE: To expand on earlier findings and investigate prepandemic rates and trends in the gallstone disease burden in the United States using national survey and claims databases.
METHODS: The National Ambulatory Medical Care Survey, National Inpatient Sample, Nationwide Emergency Department Sample, Nationwide Ambulatory Surgery Sample, Vital Statistics of the United States, Optum Clinformatics® Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample and Medicaid files 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 100000 population.
RESULTS: Gallstone disease prevalence (claims-based, 2019) was 0.70% among commercial insurance enrollees, 1.03% among Medicaid beneficiaries, and 2.09% among Medicare beneficiaries and rose over the previous decade. Recently, in the United States population, gallstone disease contributed to approximately 2.2 million ambulatory care visits, 1.2 million emergency department visits, 625000 hospital discharges, and 2000 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 United States included 605000 ambulatory laparoscopic, 280000 inpatient laparoscopic, and 49000 inpatient open procedures annually. Among commercial insurance enrollees, rates were higher compared with national data for laparoscopic procedures.
CONCLUSIONS: The gallstone disease burden in the United States is substantial and increasing, particularly among women, Hispanics, and older adults with laparoscopic cholecystectomy as the mainstay treatment. Current practice patterns should be monitored for better health care access.