Global, Regional, and National Burden of Gallbladder and Biliary Diseases in 204 Countries and Territories, 1990–2023: A Systematic Analysis for the Global Burden of Disease Study 2023

<div> Background: Gallbladder and biliary diseases (GBBDs)—including cholelithiasis, cholecystitis, cholangitis, and other non-malignant biliary tract disorders—are important contributors to global digestive disease burden and are increasingly shaped by population ageing, yet their global burden has not been comprehensively characterised. We aimed to quantify long-term trends and current patterns in prevalence, mortality, and disability associated with GBBDs across regions, countries, sexes, and ages. </div> <div> <br> </div> <div> Methods: We used estimates from the Global Burden of Disease Study 2023 to assess GBBD burden in 204 countries and territories from 1990 to 2023. Mortality was modelled using the Cause of Death Ensemble model and disease frequency using DisMod-MR 2.1. We report prevalent cases, deaths, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) as counts and age-standardised rates per 100 000 population with 95% uncertainty intervals, stratified by age, sex, region, and socio-demographic index (SDI). </div> <div> <br> </div> <div> Findings: Globally, prevalent GBBD cases, deaths, and DALYs increased substantially between 1990 and 2023, whereas corresponding age-standardised rates declined modestly. The total number of prevalent cases of GBBD in both sexes globally increased from 157.4 million (95% UI: 134.0 – 183.3) in 1990 to 264.4 million (226.0 – 309.9) in 2023. The age-standardised rate, however, declined from 3573.3 (3045.5 – 4159.1) per 100 000 in 1990 to 2990.1 (2561.5 – 3492.5) per 100 000 in 2023. Over the past three decades, females had higher age-standardised prevalence and DALY rates than males, while sex differences in mortality rates were smaller. Age-standardised prevalence and DALY rates were lowest in South Asia and high-income North America and highest in Central and Western Europe, Central Asia, and many Latin American regions. In contrast, several sub-Saharan African regions had relatively low prevalence and DALYs but comparatively high mortality. National patterns broadly mirrored these regional profiles. In 2023, prevalent cases and DALY counts peaked in middle to early-older adulthood, but age-specific rates continued to rise into the oldest age groups, with DALYs dominated by YLDs in midlife and by YLLs at older ages. Across regions, the association between SDI and age-standardised prevalence and DALY rates followed a reverse U-shaped pattern, with lowest rates at low SDI, peak rates at intermediate SDI, and declining rates at the highest SDI levels. </div> <div> <br> </div> <div> Interpretation: The global burden of GBBDs is rising in absolute terms despite declining age-standardised rates, underscoring the importance of population growth and ageing. Health systems, particularly in ageing and intermediate-SDI settings, will need to expand diagnostic, elective, and emergency surgical capacity while investing in prevention of obesity and metabolic risk factors. Marked regional and national heterogeneity highlights gaps in timely diagnosis, surgical access, and perioperative care. The predominance of non-fatal disability in midlife and rising mortality in older age groups indicates that integrated strategies spanning risk-factor control, early diagnosis, elective management, and robust acute care for older adults are essential to reduce both YLDs and YLLs. This study provides the first cause-specific GBD 2023 assessment of GBBDs with age–sex detail and DALY decomposition across 204 locations, enabling benchmarking and policy planning. </div> <div> <br> </div> <div> Funding: Gates Foundation. </div> <div></div>