Abstract
The prevalence of gallstone disease and associated factors in the entire population of subjects aged 15–65 years born and resident in Chianciano Terme (Siena — Tuscany) was examined in the years 1985 and 1986. The investigation included gallbladder ultrasonography, administration of a questionnaire on personal and family history, physical examination and blood chemistry. A total of 1809 subjects (attendance rate 87.7%) participated in the study. Personal history and physical examination showed that Chianciano inhabitants have a low prevalence of obesity (4.3%) and only 4.4% of the female population had more than two pregnancies. Overall prevalence of gallstone disease (cholecystectomy + cholelithiasis) was 5.9% (3.7% for males and 8.4% for females). Age standardized relative risk of gallstone disease for females was 2.25 (95% confidence limits=1.68−2.68). Prevalence of cholelithiasis was 3.5% (2.7% for males and 4.2% for females). Prevalence of gallstone disease increased with increasing age in both sexes, being extremely low in the age interval of 15–29 years (0.25%). The overall gallstones/cholecystectomy ratio was found to be lower (1:1) in females than in males (2.7:1). Although subjects with gallstones reported more frequently biliary colics and nonspecific dyspeptic symptoms, the diagnostic power of all symptoms in identifying cholelithiasis was very poor due to low sensitivity. Only one third of subjects with gallstones was aware of having the disease. Age, obesity and number of pregnancies were positively associated with gallstone disease in univariate analyses. The association with obesity and parity disappeared in multivariate analysis. Blood lipids and glucose were not associated with the disease both in univariate and multivariate analyses. Our data show that the prevalence of gallbladder disease in Chianciano is lower than that previously reported in Italy. This difference could be related to a lower prevalence of obesity and to a smaller number of pregnancies or to the effect of environmental and genetic factors.
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References
Brett M, Berker DJP. The world distribution of gallstones. Int J Epidemiol 1978; 5: 335–341.
Balzer K, Goebell H, Ruping KW, Leder LD. Epidemiology of gallstones in a German industrial town (Essen) from 1940–1975. Digestion 1986; 33: 189–197.
Lieber MM. The incidence of gallstones and their correlation with other diseases. Ann Surg 1952; 135: 394–405.
Teilum D. The prevalence of gallstones in autopsies from a Danish urban area. Acta Chir Scan 1989; 155: 103–106.
Nakayama F, Miyake H. Changing state of gallstone disease in Japan. Am J Surg 1970; 120: 794–799.
Friedman GD, Kannel WB, Dawber TR. The epidemiology of gallbladder disease: Observations in the Framingham Study. J Chronic Dis 1966; 19: 273–292.
Torvik A, Hoivik B. Gallstones in an autopsy series. Acta Chir Scan 1960; 120: 168–174.
Simonovis NJ, Wells CK, Feinstein AR. In vivo and post-mortem gallstones: Support for validity of the ‘Epidemiologic necropsy’ screening technique. Am J Epidemiol 1991; 133: 922–931.
Janzon L, Aspelin P, Eriksson S, Hildell J, Trell E, Ostberg H. Ultrasonographic screening for gallstone disease in middle-aged women. Scan J Gastroenterol 1985; 20: 706–710.
Zahor Z, Sternby NH, Kagan A, Uemura K, Nanecek R, Vichert AM. Frequency of cholelithiasis in Prague and Malmo: An autopsy study. Scan J Gastroenterol 1974; 9: 3–7.
Jorgensen T. Gallstones: An epidemiological investigation. Danish Med Bull 1990; 37: 336–346.
Sama C, Morselli Labate AM, Taroni F, Barbara L. Epidemiology and natural history of gallstone disease. Sem Liver Dis 1990; 10: 149–158.
Sampliner RE, Bennet PH, Comess LJ, Rose FA, Burch TA. Gallbladder disease in Pima Indians: Demonstration by early onset cholecystography. N Engl J Med 1970; 238: 1358–1364.
Cooperberg PL, Burhenne HJ. Real time ultrasonography: Diagnostic technique of choice in calculous gallbladder disease. N Engl J Med 1980; 302: 1277–1279.
Barbara L, Sama C, Morselli Labate AM, Taroni F, Rusticali AG, Festi D, Sapio C, Roda E, Banterle C, Puci A, Formentini F, Colasanti S, Nardin F. A population study on the prevalence of gallstone disease: The Sirmione study. Hepatology 1987; 7: 913–917.
Jorgensen T. Prevalence of gallstones in a Danish population. Am J Epidemiol 1987; 126: 912–921.
The Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Prevalence of gallstone disease in an Italian adult population. Am J Epidemiol 1984; 119: 796–805.
The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). The epidemiology of gallstone disease in Rome, Italy. Part I: Prevalence data in men. Hepatology 1988; 8: 904–906.
Nomura H, Kashwagi S Hayashi J, Kajiyma W, Ikematsu H, Noguchi A, Tani S, Goto M. Prevalence of gallstone disease in a general population of Okinawa, Japan. Am J Epidemiol 1988; 128: 598–605.
Khuroo MS, Mahajan R, Zargar SA, Javid G, Sapru S. Prevalence of biliary tract disease in India: A sonographic study in an adult population in Kashmir. Gut 1988; 30: 201–205.
Glambek I, Kvaale G, Arnesjo B, Soreide O. Prevalence of gallstones in a Norwegian population. Scan J Gastroenterol 1987; 22: 1089–1094.
Hanis CL, Ferrel RE, Tulloch BR, Schull W. Gallbladder disease epidemiology in Mexican Americans in Starr County, Texas. Am J Epidemiol 1985; 122: 820–829.
Heaton KW, Braddon FEM, Mountford RA, Emmett PM. Symptomatic and silent gallstones in the community. Gut 1991; 32: 316–320.
MICOL Group. Prevalence of gallstone disease in 18 Italian population samples: first result from the MICOL Group. In: Capocaccia L, Ricci G, Angelico F, Angelico M, Attili AF, Lalloni L, eds. Recent advances in the epidemiology and prevention of gallstone disease. Dordrecht (The Netherlands): Kluwer Academic Publishers, 1991.
Kono S, Kochi S, Ohyama S, Wakisaka A. Gallstones, serum lipids and glucose tolerance among male officials of self-defence forces in Japan. Dig Dis Sci 1988; 33: 839–844.
The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). The epidemiology of gallstone disease in Rome, Italy. Part II: Factors associated with the disease. Hepatology 1988; 8: 907–913.
Jorgensen T. Gallstones and plasma lipids in a Danish population. Scan J Gastroenterol 1989; 24: 916–922.
Maurer K, Everhart J, Ezzati TM, Johannes RS, Knowler WC, Larson DL, Sanders R, Shawker TH, Roth HP. Prevalence of gallstone disease in the Hispanic population in the United States. Gastroenterology 1989; 96: 487–492.
Pixley F, Wilson D, McPherson K, Mann J. Effect of vegetarianism on development of gallstones in women. Br Med J 1985; 291: 11–12.
Progetto Distretto Sezze Controllo Comunitario (DISCO), the Natural Research Council and the Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). Epidemiology of gallstone disease in Italy: Comparison between a rural and urban female population. Italian J Gastroenterol 1987; 19: 129–133.
Expert Panel. Report of the National Cholesterol Education Program: expert panel on detection evaluation and treatment of high blood cholesterol in adults. Arch Intern Med 1988; 148: 36–69.
International Committee for the Evaluation of Hypertriglyceridemia as a Vascular Risk Factor. The hypertriglyceridemias: Risk and management. Am J Cardiology 1991; 68: 1A-42A.
Hadlai HC, Nie NH. SPSS update 7–9: New procedures and facilities for releases 7–9. New York: McGraw-Hill 1981.
Norusis MJ. SPSS/PC+. Chicago, IL: SPSS Inc., 1986.
Dixon WJ, Brown MB, Engelman L, Jennrich RI. BMDP Statistical software manual. Berkeley, CA: University of California Press, 1990.
Cochran WG. Some methods for strengthening the common χ2 test. Biometrics 1954; 10: 417–441.
Dixon WJ, Massey WJ. Introduction to statistical analysis, 3rd ed. New York: Mc Graw-Hill, 1969.
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1954; 22: 719–748.
Miettinen OS. Estimability and estimation in case-referent studies. Am J Epidemiol 1976; 103: 226–235.
Capocaccia R, the Grepco Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Logistic regression analysis in epidemiological research. In: Epidemiology and prevention of gallstone disease. Capocaccia L, Ricci G, Angelico F, Angelico M, Attili AF, eds. Lancaster (UK): MTP Press 1984: 223–231.
Hosmer DW, Lemeshoow S. Applied logistic regression. New York: John Wiley & Sons, 1989.
Bennion LJ, Grundy SM. Risk factors for the development of cholelithiasis in man, II. N Engl J Med 1978; 30: 1221–1227.
Bainton D, Davies GT, Evans KT, Gravelle H. Gallbladder disease: Prevalence in South Wales industrial town. N Engl J Med 1976; 294: 1147–1149.
Kern F, Everson GT, De Mark B, McKinley C, Showalter R, Braverman DZ, Szczepanik-Van Leeuwen P, Klein DP. Biliary lipids, bile acids and gallbladder function in the human female: Effect of pregnancy and the ovulatory cycle. J Clin Invest 1981; 68: 1229–1242.
Everson GT, McKinley C, Lawson M, Johnson M, Kern F. Gallbladder function in the human female: Effect of the ovulatory cycle, pregnancy and contraceptive steroids. Gastroenterology 1982; 82: 711–719.
Glambek I, Arnesjo B, Soreide O. Correlation between gallstones and abdominal symptoms in a random population: Results from a screening study. Scan J Gastroenterol 1989; 24: 277–281.
Jorgensen T. Abdominal symptoms and gallstone disease: An epidemiological investigation. Hepatology 1989; 9: 856–860.
The Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Radiologic appearance of gallstones and its relationship with biliary symptoms and awareness of having gallstones: Observation during epidemiological studies. Dig Dis Sci 1987; 32: 349–353.
Thistle JL, Cleary PA, Lachin JM, Tylor MP, Hersh T. The Steering Committee and the National Cooperative Gallstone Study Group. The natural history of cholelithiasis: The National Cooperative Gallstone Study. Ann Int Med 1987; 101: 171–175.
Schoenfield LJ, Carulli N, Dowling RH, Sama C, Wolpers C. Asymptomatic gallstones: Definition and treatment. Gastroent Int 1989; 2: 25–29.
Attili AF, Lalloni L, the Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Natural history of gallstones (GS): A four to six year follow-up study of asymptomatic and symptomatic gallstones. Italian J Gastroenterol 1989; 21: 310 (abstract).
Festi D, Barbara L, Frabboni R, Morselli Labate AM, Nacchiero MC, Parro S, Pollini G, Roda E, Rossi M, Rusticali AG, Sama C, Taroni F, Tassinari G, Banterle C, Colasanti S, Formentini G, Martori A, Moreni O, Nardin F, Pilia MC, Puci A. Natural history of gallstone disease: The ‘Sirmione Study’. Italian J Gastroenterol 1989; 21: 310 (abstract).
Jorgensen T. Gallstones in a Danish population: Fertility period, pregnancies, and exogenous female sex hormones. Gut 1988; 29: 433–439.
Jorgensen T. Gallstones in a Danish population: Relation to weight, physical activity, smoking, coffee consumption and diabetes mellitus. Gut 1989; 30: 528–534.
Maurer KR, Everhart JE, Knowler WC, Shawker TH, Roth HP. Risk factors for gallstone disease in the Hispanic populations of the United States. Am J Epidemiol 1990; 131: 836–844.
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Dr Loria, P., Dilengite, M.A., Bozzoli, M. et al. Prevalence rates of gallstone disease in Italy. Eur J Epidemiol 10, 143–150 (1994). https://doi.org/10.1007/BF01730363
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DOI: https://doi.org/10.1007/BF01730363