Changes in gallbladder cancer mortality and hospital discharges due to preventive cholecystectomy in Chile
In the first years of Chile's preventive gallbladder surgery guarantee, deaths from gallbladder cancer among 35 to 49 year olds fell twice as fast as before, but the national trend did not visibly change.
Overview
Analysis of Chilean Ministry of Health mortality and hospital discharge databases for 2002 to 2014, standardised to the 2002 Chilean population, with Poisson regression for trends by region, sex and age, comparing the periods before and after the GES guarantee. Nationally there was a 4.5 percent decreasing mortality trend compared with before GES. Among people aged 35 to 49, mortality fell by 4 percent per period before GES and 8 percent after. Hospital discharges for biliary disease moved from a 1 percent decrease before GES to a 2 percent increase after, and in the 35 to 49 group from 0.1 to 2.9 percent. The authors conclude the rise in operations had not yet produced a break in the national mortality trend but did benefit the targeted age group.
- National gallbladder cancer mortality trend 4.5 percent lower than before GES.
- Mortality at ages 35 to 49 fell 4 percent before GES and 8 percent after; discharges in that group rose from 0.1 to 2.9 percent.
Together with the 2024 evaluation and the American Journal of Epidemiology analysis, this is the evidence base for whether a prophylactic cholecystectomy policy prevents gallbladder cancer deaths: suggestive in the target age band, not yet convincing nationally.
- Ecological before-and-after design; secular trends and improved treatment are alternative explanations.
- Follow-up to 2014 is short for a cancer with a long induction period.
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