Research and analysis on basic clinical characteristics of inpatients with benign gallbladder diseases: a big-data retrospective analysis

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Methods A total of 36,298 patients admitted to the gallstone center of a tertiary hospital in Shanghai between 2019 and 2024 for benign gallbladder diseases were included in the study. Basic patient information was collected from the electronic medical records system in accordance with the international classification of diseases. Descriptive statistics and Multinomial logistic regression methods were employed to analyze the clinical characteristics of patients and identify risk factors associated with gallbladder inflammatory conditions. Results The mean age of patients with gallstones was 50.21 ± 15.31 years, 43.90 ± 13.53 years for gallbladder polyps, and 49.36 ± 13.28 years for gallbladder adenomyosis. The overall gender ratio in the gallstone population was approximately 1:1.38(male:female = 13175:18304), gallbladder polyps was 1.03:1(male:female = 3198:3113) and gallbladder adenomyosis was 1:1.28(male:female = 1057:1351); the risk of gallbladder stones in menstruation women is 0.625 times that in postmenopausal (95% CI: 0.575–0.680, p < 0.0001), and gallbladder polyps were 1.555 times(95% CI: 1.439–1.680, p < 0.0001). Multinomial logistic regression analysis demonstrated that age, male, gallstones, common bile duct stones(CBDS) and diabetes mellitus(DM) were significantly associated with the inflammatory state of the gallbladder(all p < 0.001). Conclusion Gallstones is the primary cause of hospitalisation for benign gallbladder disease, and the risk is higher in postmenopausal women. Middle age, male, gallstones, CBDS and DM are identified as risk factors for gallbladder inflammation. The clinical characteristics of patients with gallbladder polyps and adenomyosis are similar to those reported in the general population in existing literature gallbladder stones gallbladder polyps gallbladder adenomyosis gallbladder inflammation Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Benign gallbladder diseases are among the most common digestive diseases worldwide, especially in developed and developing countries, and impose a significant economic burden on society. It is reported that about 20 million to 25 million adults in the United States have gallstones, and the annual medical burden directly or indirectly caused by gallstones is about 6.2 billion US dollars 1 – 3 . In the UK, the financial burden of gallstones on the NHS exceeded 200 million pounds in the 2018/19 4 . Benign gallbladder diseases mainly include gallstones, gallbladder polyps and gallbladder adenomyosis. The global prevalence of gallstones is estimated to range from 6–25% 4–7 , that of gallbladder polyps from 0.3–9.5% 8–11 , and that of gallbladder adenomyosis from 2–9% 12–14 . The prevalence of gallstones is higher in women, with a male-to-female ratio of approximately 1:1-3.92 1,15,16 . This difference is mainly related to ethnic factors; gallbladder adenomyosis manifests more frequently in women 14 , 17 , 18 ; and gallbladder polyps are more prevalent in men 9 , 19 , 20 (male:female = 1.15–1.7:1). The prevalence of gallstones increases significantly after the age of 40, especially in women 1 , 5 , 21 , 22 . As individuals age, symptoms often become more subtle, and treatment is often complicated by serious complications, making surgery significantly more difficult. Gallbladder polyps are predominantly observed in individuals between the ages of 40 and 59 years 19 , 20 , 23 – 25 , but their incidence of clinical symptoms is low, and their potential cancer risk cannot be ignored. Gallbladder adenomyosis, like gallbladder polyps, has a low incidence of symptoms, and its cancer risk is mainly related to classification. Segmental adenomyosis has a higher cancer risk, especially in elderly patients 26 . The primary risk factors associated with gallstone formation can be classified into two categories: congenital and acquired 1 , 5 , 27 – 35 . Congenital factors include female, advancing age, family history and race. Acquired factors include blood Se, diet, rapid weight loss, obesity, physical activity, drugs and total parenteral nutrition. For example, dyslipidemia, diabetes, metabolic syndrome, and some chronic diseases (such as hemolytic diseases, chronic liver disease, and Crohn's disease) are a combination of congenital and acquired factors. The primary risk factors for gallbladder polyps include male, dyslipidemia, HBsAg positivity, and age 9 , 10 , 19 , 20 (especially middle age). Gallbladder adenomyosis is closely related to gallbladder stones, chronic inflammation of the gallbladder and increased intra-luminal pressure 13 , 26 , 36 – 38 . As can be seen from the above epidemiological characteristics, the risk factors associated with benign gallbladder diseases involve many aspects of life. The combined effect of these factors makes it the most common digestive disease with the highest incidence and medical burden. This prompts the question of the treatment concept for benign gallbladder diseases, which is mainly based on the concepts of cholecystectomy and conservative treatment with subsequent follow-up observation. With the advent of minimally invasive surgery, innovations in endoscopic technology have promoted the popularisation of laparoscopic cholecystectomy. At the same time, some scholars have proposed laparoscopic cholecystotomy and stone removal and other surgical methods that preserve the function of the gallbladder based on the concept of precision medicine 39 , which has also greatly increased the number of surgeries for benign gallbladder diseases. The primary risks that increase the difficulty of laparoscopic cholecystectomy are the inflammatory condition of the gallbladder and anatomical abnormalities. The most serious adverse event is bile duct injury 40 . In particular, the incidence of gallbladder inflammation is significantly higher than that of anatomical abnormalities. Gallbladder inflammation causes oedema and dense adhesion of the surrounding tissues of the gallbladder, and the anatomical landmarks in the gallbladder triangle cannot be identified, which easily causes bile duct injury. These factors can significantly prolong the patient's hospital stay and increase hospital costs. It is worth noting that these epidemiological characteristics are mainly based on data collected after inpatient treatment, which differs from the epidemiological surveys conducted on large-scale health examination populations. Therefore, the primary objective of this study is to analyze the clinical characteristics of hospitalized patients with benign gallbladder diseases based on a large dataset, and compare these findings with those from the physical examination population in existing literature. Methods Research methods and subjects This is a retrospective big data study that included 36,298 patients with benign gallbladder diseases who underwent treatment at the largest gallstone centre in China from January 2019 to December 2024. The centre treats approximately 6,000 to 8,000 patients with benign gallbladder diseases each year, and has the basic conditions for big data analysis. All benign gallbladder diseases were diagnosed according to the International Classification of Diseases(ICD) codes, including gallstones (K80), gallbladder polyps (K82.802) and gallbladder adenomyosis (K82.803). This study was approved by the Medical Ethics Committee of Dongfang Hospital(No [2022] Review Document No. (107)), Tongji University, Shanghai, China. Therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all participants in this study (Patients under the age of 18 have obtained the informed consent of their legally responsible persons). Diagnostic criteria: Gallstones, gallbladder polyps and gallbladder adenomyosis were diagnosed based on imaging examinations of the ultrasound, abdominal CT and magnetic resonance cholangiopancreatography (MRCP), combined with the patient's clinical symptoms. The above diseases were diagnosed according to the ‘gold standard’ of pathology after surgery. Inclusion criteria: 1. Gallstone diagnosed according to ICD-10 K80; 2. Gallbladder polyps diagnosed according to ICD-10 K82.802; 3. Gallbladder adenomyosis diagnosed according to ICD-10 K82.803; 4. Patients who received inpatient treatment at this center and had detailed basic demographic information. Exclusion criteria: Basic characteristic information is missing for more than 30% of patients. Data collection Gender, Age, Length of stay, Hypertension, DM, coronary heart disease (CHD), CBDS and Dyslipidaemia (including hypercholesterolaemia, hypertriglycerolaemia and mixed hyperlipidaemia) of all patients were collected from the electronic medical records of hospital information system (HIS). Patients were geographically distributed according to their residential address (Northeast, Eastern, Central, North, Southern, Northwest, Southwest). Gallbladder inflammation is classified into three states of disorder(no inflammation or chronic cholecystitis, acute seizure, perforation of gangrenous origin). Acute seizure includes the following international disease codes K80.000 or K80.002 or K81.000 or K81.002 or K81.006; Perforation of gangrenous origin includes the following international codes: K80.001 or K81.003 or K82.200 or K81.008 or K81.005. Females are divided into menstruation and postmenopausal. Due to system limitations, it is not possible to fully obtain the patient's true menstruation status. According to previous literature reports, females over the age of 50 are classified as post-menopausal after extensive consideration 41 – 43 . Statistical analysis Descriptive statistical analysis was performed on the collected data, summarising the central tendency and dispersion of continuous variables and the frequency and percentage of categorical variables. Comparisons between groups of categorical variables were assessed using Pearson's chi-squared test or Fisher's exact test. Multinomial logistic regression analysis was used to assess risk factors associated with gallbladder inflammation. The variance inflation factor (VIF) was used to diagnose multiple collinearity for the included independent variables, thereby improving the stability and validity of the model. Variables with P < 0.05 in univariate analysis were then included in Multinomial logistic regression analysis. IBM SPSS Statistics version 27 and R version 4.3.0 were used for data analysis. A two-tailed p value of less than 0.05 was considered statistically significant. Results 1. Basic characteristics of benign gallbladder diseases The mean age of patients with gallstones was 50.21 ± 15.31 years, gallbladder polyps was 43.90 ± 13.53 years and gallbladder adenomyosis was 49.36 ± 13.28 years (Table 1). Figure 1 illustrates the age distribution of benign gallbladder diseases. It is evident that the incidence of gallstones increases steadily after the age of 20 years, peaking between the ages of 30 and 45 years, followed by a slight decrease in growth, and another peak between the ages of 55 and 70 years, after which the trend gradually declines; Gallbladder polyps peak between the ages of 30 and 40 years, with a gradual decline thereafter. Gallbladder adenomyosis generally peaks between the ages of 35 and 65 years, with a gradual decline after the age of 65 years. The overall gender ratio in the gallstone population was approximately 1:1.38(male:female = 13175:18304), gallbladder polyps was 1.03:1(male:female = 3198:3113) and gallbladder adenomyosis was 1:1.28(male: female = 1057:1351) (Table 1). Figure 2 shows the gender distribution of benign gallbladder diseases. All three types of benign gallbladder diseases were more prevalent in economically developed regions (Eastern China), and the proportion of gallstones with acute seizure (23.9%) was higher than that of other benign gallbladder diseases (Table 1). Table 1 Basic features of benign gallbladder disease Variables Gallbladder stones N = 31479 Gallbladder polyps N = 6311 Gallbladder adenomyosis N = 2408 Age 50.21 ± 15.31 43.90 ± 13.53 49.36 ± 13.28 Gender Female 18304(58.1%) 3113(49.3%) 1351(56.1%) Male 13175(41.9%) 3198(50.7%) 1057(43.9%) Common bile duct stones 726(2.3%) 12(0.2%) 14(0.6%) Dyslipidemia 257(0.8%) 37(0.6%) 23(1%) Hypertension 5094(16.2%) 632(10%) 305(12.7%) Diabetes Mellitus 2052(6.5%) 203(3.2%) 101(4.2%) Coronary heart disease 965(3.1%) 64(1%) 35(1.5%) Region Northeast China 486(1.5%) 120(1.9%) 45(1.9%) Eastern China 29851(94.8%) 5933(94%) 2272(94.4%) Central China 376(1.2%) 91(1.4%) 24(1%) North China 212(0.7%) 55(0.9%) 24(1%) Southern China 64(0.2%) 20(0.3%) 8(0.3%) Northwest China 161(0.5%) 25(0.4%) 8(0.3%) Southwest China 201(0.6%) 35(0.6%) 14(0.6%) Inflammatory state of the gallbladder No or chronic inflammation 22906(72.8%) 5890(93.3%) 2255(93.6%) Acute seizure 7532(23.9%) 413(6.5%) 148(6.1%) Perforation of gangrenous origin 1041(3.3%) 8(0.1%) 5(0.2%) Duration of hospitalisation 2(2,4) 2(2,3) 2(2,3) 2. Distribution characteristics of benign gallbladder diseases Figure 3 shows the distribution of benign gallbladder diseases, including 28140 (77.52%) with gallstones only, 3784(10.42%) with gallbladder polyps, and 684(1.88%) with gallbladder adenomyosis; 1966(5.42%) with both gallstones and gallbladder polyps, gallstones and gallbladder adenomyosis 1163(3.2%), gallbladder polyps and gallbladder adenomyosis 351(0.97%); 210(0.58%) had all three of the above-mentioned benign gallbladder diseases simultaneously. 3. The risk of benign gallbladder disease associated with menstruation in women In the female subgroup, the risk of benign gallbladder diseases associated with menstruation was analysed. The risk of gallstones in menstruation women was significantly lower than in postmenopausal women(85.28% vs 90.26%, OR: 0.625, 95%CI: 0.575–0.680, p < 0.0001); The risk of gallbladder polyps was higher in postmenopausal women(17.66% vs 12.12%, OR: 1.555, 95%CI: 1.439–1.680, p 0.05) (Fig. 4). 4. Multinomial-logistic regression analysis of factors to inflammatory state of the gallbladder The independent variables of age, gender, gallbladder stones, gallbladder polyps, gallbladder adenomyosis, CBDS, dyslipidemia, hypertension, DM and CHD were included in a linear regression model for multicollinearity diagnosis. It was found that the VIF was less than 5, so multicollinearity between the independent variables was ruled out. Multinomial logistic regression analysis was conducted with the absence of inflammation or chronic cholecystitis in the gallbladder as the reference category. The results showed that age, gender, gallbladder stones, gallbladder polyps, gallbladder adenomyosis, CBDS, hypertension, DM, and CHD were significantly associated with the inflammatory state of the gallbladder (all p 30 years had an increased risk. The risk of acute seizure was higher in individuals aged 45–60 years(OR: 1.848; 95% CI: 1.618–2.114, p < 0.001), while the risk of perforation of gangrenous origin was higher in individuals aged 30–45 years(OR: 3.165; 95% CI: 2.242–4.464, p < 0.001); Male had a higher risk of acute seizure(OR: 1.333; 95% CI: 1.265–1.406, p < 0.001) and perforation of gangrenous origin(OR: 2.196; 95% CI: 1.934–2.494, p < 0.001) than female; Gallstones were associated with a higher risk of acute seizure(OR: 2.857; 95% CI: 2.370–3.436, p < 0.001); Gallbladder polyps and gallbladder adenomyosis were associated with a lower risk of acute seizure or perforation of gangrenous origin(both p < 0.001); CBDS were associated with a higher risk of acute seizure(OR: 2.024; 95% CI: 1.727–2.370, p < 0.001) and perforation of gangrenous origin(OR: 2.481; 95% CI: 1.848–3.333, p < 0.001);DM was associated with a higher risk of acute seizure(OR: 1.316; 95% CI: 1.183–1.462, p < 0.001) and perforation of gangrenous origin(OR: 1.773; 95% CI: 1.425–2.208, p < 0.001); Hypertension was associated with a higher risk of acute seizure(OR: 1.304; 95%CI: 1.209–1.406, P < 0.001); CHD was associated with a higher risk of acute seizure(OR: 1.328; 95%CI: 1.149–1.534, P < 0.001) Table 2 Multinomial-logistic regression analysis of factors to inflammatory state of the gallbladder Variables Acute seizure Perforation of gangrenous origin Coefficient SE OR(95%Cl) p Coefficient SE OR(95%Cl) p Age ≦ 30 Ref Ref > 30,≦ 45 0.598 0.077 1.818(1.563–2.119) < 0.001 1.151 0.176 3.165(2.242–4.464) 45,≦ 60 0.615 0.069 1.848(1.618–2.114) < 0.001 0.797 0.138 2.217(1.695–2.907) 60,≦ 75 0.530 0.067 1.698(1.488–1.938) < 0.001 0.982 0.137 2.667(2.041–3.497) 75 0.360 0.066 1.435(1.259–1.631) < 0.001 0.555 0.130 1.742(1.351–2.247) < 0.001 Gender Female Ref Ref Male 0.288 0.027 1.333(1.265–1.406) < 0.001 0.787 0.065 2.196(1.934–2.494) < 0.001 Gallbladder polyps No Ref Ref Yes -0.935 0.067 0.392(0.344–0.448) < 0.001 -2.463 0.356 0.085(0.042–0.171) < 0.001 Gallbladder adenomyosis No Ref Ref Yes -1.190 0.089 0.304(0.256–0.362) < 0.001 -2.355 0.450 0.095(0.039–0.229) < 0.001 Gallbladder stones No Ref Ref Yes 1.048 0.095 2.857(2.370–3.436) < 0.001 - - - - Common bile duct stones No Ref Ref Yes 0.705 0.081 2.024(1.727–2.370) < 0.001 0.909 0.150 2.481(1.848–3.333) < 0.001 Dyslipidemia No Ref Ref Yes 0.214 0.137 1.238(0.946–1.621) 0.119 0.081 0.333 1.085(0.564–2.083) 0.922 Hypertension No Ref Ref Yes 0.266 0.039 1.304(1.209–1.406) < 0.001 0.030 0.092 1.031(0.861–1.233) 0.742 Diabetes Mellitus No Ref Ref Yes 0.274 0.054 1.316(1.183–1.462) < 0.001 0.572 0.112 1.773(1.425–2.208) < 0.001 Coronary heart disease No Ref Ref Yes 0.284 0.073 1.328(1.149–1.534) < 0.001 -0.030 0.167 0.970(0.700-1.344) 0.856 Discussion This study is one of the largest clinical studies on inpatients with benign gallbladder diseases. Unlike previous studies based on large-scale physical examination populations, this study found that among inpatients with benign gallbladder diseases, the proportion of those with gallstones was as high as 86.72%, gallbladder polyps 17.39%, and gallbladder adenomyosis 5.66%. The main reason is that the movability of gallstones, with the contraction of the gallbladder and changes in body position, the stones can easily become lodged in the neck of the gallbladder or the cystic duct, which in turn can trigger typical clinical symptoms, or damage gallbladder function through chronic inflammation and irritation over the long term, leading to nonspecific manifestations. Therefore, compared to gallbladder polyps and gallbladder adenomyosis, which have a lower incidence of clinical symptoms, gallstone disease requires hospitalization in significantly more patients. This study found that the incidence of gallstones combined with gallbladder polyps was 6%, which is similar to the 0.25%-6.5% reported in the literature 10 , 19 , 20 , and also describes the overlapping characteristics of these three diseases. Further analysis revealed that the prevalence of gallstones showed two peaks in the age distribution, one between 30 and 45 years and another between 55 and 70 years, followed by a gradual decline. This may be due to the fact that as people get older, their perception of symptoms decreases and they become less sensitive to symptoms. The proportion of patients requiring inpatient treatment begins to decrease. However, it should be noted that while symptoms can be subtle, when they occur, they often result in more serious complications. In contrast to this study and previous research, a study that included 438 cases of gallbladder polyps and followed them up for 6 years found that the incidence of gallbladder polyps was higher in middle-aged women 24 (female:male = 1.44:1), which may be due to differences in sample size. Overall, the age and gender distribution characteristics of gallstones, gallbladder polyps and gallbladder adenomyosis are similar to previous studies 1 , 5 , 9 , 14 – 25 . It is well known that women are one of the main risk factors for gallstones, which is closely related to their sex hormone levels, number of births, use of oral contraceptives, and estrogen replacement therapy 1 , 44 , 45 . During pregnancy in particular, 5–30% of women will develop microstones or sludge in the gallbladder 46 , 47 , but most of these will gradually disappear after pregnancy. This gender gap gradually narrows after menopause. Further research found that the risk of gallstones in menstruation women was 0.625 times that of postmenopausal women (95% CI: 0.575–0.680, p < 0.0001). These results differ significantly from those of other studies 48 . In this study, postmenopausal women did not receive estrogen replacement therapy, but the incidence of gallstones was 1.6 times that of menstruating women. There are two possible reasons for this phenomenon: First, the significant decline in estrogen levels in postmenopausal women leads to abnormal lipid metabolis, which in turn causes abnormalities in the bile microenvironment in the gallbladder, bile stasis, and cholesterol supersaturation 49 . Second, as individuals age, the contractile function of the gallbladder naturally declines. This study focused on the inflammatory state of the gallbladder and performed a multinomial logistic regression analysis, and found that age, male, gallstones, CBDS, hypertension, CHD and DM were significantly associated with the inflammatory state of the gallbladder (all p < 0.001). Age 45–60 years(OR: 1.848; 95%CI: 1.618–2.114, P < 0.001), gallbladder stones(OR: 2.857; 95%CI: 2.370–3.436, P < 0.001) and CBDS(OR: 2.024; 95%CI: 1.727–2.370, P < 0.001) were associated with a higher risk of acute seizure; Additionally, age 30–45 years(OR : 3.165; 95%CI: 2.242–4.464, P < 0.001), male(OR: 2.196; 95%CI: 1.934–2.494, P < 0.001) and the presence of CBDS(OR: 2.481; 95%CI: 1.848–3.333, P < 0.001) were associated with a higher risk of gallbladder perforation of gangrenous origin. When managing patients with benign gallbladder diseases, special attention should be given to the above-mentioned characteristic populations, and careful examinations should be performed. During surgery, the aim should be to remove the lesion as much as possible, rather than completely resecting the gallbladder radically, in order to minimise the difficulty of the operation and avoid bile duct injury A big data study of inpatients with benign gallbladder disease has the potential to contribute to two key areas of research. Firstly, it can provide valuable epidemiological information on the population of inpatients. Secondly, it can further refine clinical management strategies for the disease. Benign gallbladder diseases is one of the most economically burdensome diseases in the digestive system. It has a high incidence rate and there are also differences in treatment concepts. In clinical practice, some patients frequently visit the doctor for different opinions provided by different doctors. This can cause significant anxiety for patients and also result in a considerable waste of medical resources. The root cause is that doctors differ in their judgments as to whether intervention is necessary. By conducting a large data survey of inpatients with benign gallbladder diseases, high-risk patients can be identified early, so that early diagnosis and treatment can be achieved, the occurrence of complications can be reduced, and bile duct damage caused by increased surgical difficulty due to delayed treatment can be avoided. Based on the concept of precision medicine in modern medicine and artificial intelligence big data models, individualized treatment combined with prevention can better achieve precision treatment and avoid wasting medical resources. In summary, gallstones are the main cause of hospitalization for benign gallbladder diseases, and the risk is higher in postmenopausal women. Middle age, male, gallstones, CBDS and DM are risk factors for inflammatory reactions in the gallbladder. The basic clinical characteristics of patients with gallbladder polyps and gallbladder adenomyosis are similar to those of healthy people. This study still has limitations. Due to medical data restrictions, most details of the hospitalised patients with these benign gallbladder diseases, including body mass index, true menstruation status, clinical manifestations, blood lipid levels, liver function and inflammatory indicators, were not fully obtained. Consequently, a comparison with the local health examination population from the same period could not be made, and the study could only be compared with previous large-scale epidemiological studies of benign gallbladder diseases. Abbreviations CBDS Common Bile Duct Stones DM Diabetes Mellitus US United States UK United Kingdom NHS National Health Service ICD International Classification of Diseases MRCP Magnetic Resonance Cholangiopancreatography CHD Coronary Heart Disease HIS Hospital Information System VIF Variance Inflation Factor. Declarations Ethics approval and consent to participate: This study was approved by the Medical Ethics Committee of Dongfang Hospital(No [2022] Review Document No. (107)), Tongji University, Shanghai, China. Therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all participants in this study (Patients under the age of 18 have obtained the informed consent of their legally responsible persons). Consent for publication: Not Applicable. Availability of data and materials: The datasets generated and/or analysed during the current study are not publicly available due this study involves private information of the participating patients and in accordance with hospital regulations, disclosure of any patient information is strictly prohibited. but are available from the corresponding author on reasonable request. Competing Interests: The authors declare that they have no competing interests in this study. Funding: Key Specialty Construction Project of Shanghai Pudong New Area Health Commission (PWZzk2022-17); The Featured Clinical Discipline Project of Shanghai Pudong (PWYts2021-06); Clinical Research Project of Shanghai East Hospital (DFLC2022019) Authors' contributions: All authors contributed to the study conception and design. Honglei Zhang: conceptualization, methodology, writing the manuscript and reviewing the references; Cheng Zhang, Chen Qiu and Yukai Xiang: collecting the data and performing the experiments; Chen Qiu and Yukai Xiang: data organization and analysis; Honglei Zhang and Cheng Zhang: integrating the pictures and making the tables. Zhaoyan Jiang and Liang Zheng: critically reviewed the study proposal and technical editing of the manuscript. Yulong Yang and Hai Hu: conceptualization, methodology, supervising the research and revising the manuscript. 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Yoon JH, Cha SS, Han SS, Lee SJ, Kang MS. Gallbladder adenomyomatosis: imaging findings. Abdom Imaging 2006; 31 (5): 555-63. Park JY, Hong SP, Kim YJ, et al. Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol 2009; 24 (2): 219-22. Mao YS, Mai YF, Li FJ, et al. Prevalence and risk factors of gallbladder polypoid lesions in Chinese petrochemical employees. World J Gastroenterol 2013; 19 (27): 4393-9. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005; 7 (2): 132-40. Einarsson K, Nilsell K, Leijd B, Angelin B. Influence of age on secretion of cholesterol and synthesis of bile acids by the liver. N Engl J Med 1985; 313 (5): 277-82. Kamaya A, Fung C, Szpakowski JL, et al. Management of Incidentally Detected Gallbladder Polyps: Society of Radiologists in Ultrasound Consensus Conference Recommendations. Radiology 2022; 305 (2): 277-89. Hajibandeh S, Ashar S, Parry C, Ellis-Owen R, Kumar N. The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication. J Gastroenterol Hepatol 2023; 38 (12): 2247-53. Foley KG, Lahaye MJ, Thoeni RF, et al. Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE. Eur Radiol 2022; 32 (5): 3358-68. Nabatame N, Shirai Y, Nishimura A, Yokoyama N, Wakai T, Hatakeyama K. High risk of gallbladder carcinoma in elderly patients with segmental adenomyomatosis of the gallbladder. J Exp Clin Cancer Res 2004; 23 (4): 593-8. Unalp-Arida A, Ruhl CE. Increasing gallstone disease prevalence and associations with gallbladder and biliary tract mortality in the US. Hepatology 2023; 77 (6): 1882-95. Lim J, Wirth J, Wu K, et al. Obesity, Adiposity, and Risk of Symptomatic Gallstone Disease According to Genetic Susceptibility. Clin Gastroenterol Hepatol 2022; 20 (5): e1083-e120. Wirth J, Joshi AD, Song M, et al. A healthy lifestyle pattern and the risk of symptomatic gallstone disease: results from 2 prospective cohort studies. Am J Clin Nutr 2020; 112 (3): 586-94. Wang J, Sun YX, Xiang S, et al. The association between blood heavy metals and gallstones: A cross-sectional study. Sci Total Environ 2023; 904 : 166735. Chen L, Yang H, Li H, He C, Yang L, Lv G. Insights into modifiable risk factors of cholelithiasis: A Mendelian randomization study. Hepatology 2022; 75 (4): 785-96. Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol 2006; 20 (6): 981-96. Mi N, Yang M, Wei L, et al. Gallstone Disease Is Associated With an Increased Risk of Inflammatory Bowel Disease: Results From 3 Prospective Cohort Studies. Am J Gastroenterol 2025; 120 (1): 204-12. Chen J, Yuan S, Fu T, et al. Gastrointestinal Consequences of Type 2 Diabetes Mellitus and Impaired Glycemic Homeostasis: A Mendelian Randomization Study. Diabetes Care 2023; 46 (4): 828-35. Wang J, Shen S, Wang B, et al. Serum lipid levels are the risk factors of gallbladder stones: a population-based study in China. Lipids Health Dis 2020; 19 (1): 50. Kai K. Organ-specific concept and controversy for premalignant lesions and carcinogenesis of gallbladder cancer. Hepatobiliary Surg Nutr 2016; 5 (1): 85-7. Nishimura A, Shirai Y, Hatakeyama K. Segmental adenomyomatosis of the gallbladder predisposes to cholecystolithiasis. J Hepatobiliary Pancreat Surg 2004; 11 (5): 342-7. Kim JH, Jeong IH, Han JH, et al. Clinical/pathological analysis of gallbladder adenomyomatosis; type and pathogenesis. Hepatogastroenterology 2010; 57 (99-100): 420-5. Liu J, Zhu X, Zhao Q, et al. A new operation for gallstones: Choledochoscopic gallbladder-preserving cholecystolithotomy, a retrospective study of 3,511 cases. Surgery 2022; 172 (5): 1302-8. Brunt LM, Deziel DJ, Telem DA, et al. Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy. Ann Surg 2020; 272 (1): 3-23. Reynolds RF, Obermeyer CM. Age at natural menopause in Spain and the United States: results from the DAMES project. Am J Hum Biol 2005; 17 (3): 331-40. Poniatowski BC, Grimm P, Cohen G. Chemotherapy-induced menopause: a literature review. Cancer Invest 2001; 19 (6): 641-8. Dratva J, Gómez Real F, Schindler C, et al. Is age at menopause increasing across Europe? Results on age at menopause and determinants from two population-based studies. Menopause 2009; 16 (2): 385-94. Cirillo DJ, Wallace RB, Rodabough RJ, et al. Effect of estrogen therapy on gallbladder disease. Jama 2005; 293 (3): 330-9. Etminan M, Delaney JA, Bressler B, Brophy JM. Oral contraceptives and the risk of gallbladder disease: a comparative safety study. Cmaj 2011; 183 (8): 899-904. Celaj S, Kourkoumpetis T. Gallstones in Pregnancy. Jama 2021; 325 (23): 2410. Maringhini A, Ciambra M, Baccelliere P, et al. Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med 1993; 119 (2): 116-20. Simonsen MH, Erichsen R, Frøslev T, Rungby J, Sørensen HT. Postmenopausal estrogen therapy and risk of gallstone disease: a population-based case-control study. Drug Saf 2013; 36 (12): 1189-97. Knowlton AA, Lee AR. Estrogen and the cardiovascular system. Pharmacol Ther 2012; 135 (1): 54-70. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6700349","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":498350919,"identity":"d8c8b30b-933e-4f8d-89f3-55a50e1d2b36","order_by":0,"name":"Honglei Zhang","email":"","orcid":"","institution":"1Center for Gallbladder Diseases of Shanghai East Hospital affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Honglei","middleName":"","lastName":"Zhang","suffix":""},{"id":498350920,"identity":"ebf13f66-18c0-499a-9875-57a22a4152d3","order_by":1,"name":"Cheng Zhang","email":"","orcid":"","institution":"1Center for Gallbladder Diseases of Shanghai East Hospital affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Cheng","middleName":"","lastName":"Zhang","suffix":""},{"id":498350921,"identity":"33df99c2-05dd-455c-af94-3e90b5b095ce","order_by":2,"name":"Chen Qiu","email":"","orcid":"","institution":"1Center for Gallbladder Diseases of Shanghai East Hospital affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Qiu","suffix":""},{"id":498350922,"identity":"93c07943-d33c-4bd7-914c-f54fc5211b7f","order_by":3,"name":"Yukai Xiang","email":"","orcid":"","institution":"1Center for Gallbladder Diseases of Shanghai East Hospital affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yukai","middleName":"","lastName":"Xiang","suffix":""},{"id":498350923,"identity":"e89ebf31-df86-4584-ad16-7d8eea753b4f","order_by":4,"name":"Zhaoyan Jiang","email":"","orcid":"","institution":"1Center for Gallbladder Diseases of Shanghai East Hospital affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhaoyan","middleName":"","lastName":"Jiang","suffix":""},{"id":498350924,"identity":"ccae512b-38b6-4fd5-a8b3-a0d9647c779d","order_by":5,"name":"Liang Zheng","email":"","orcid":"","institution":"1Center for Gallbladder Diseases of Shanghai East Hospital affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Liang","middleName":"","lastName":"Zheng","suffix":""},{"id":498350925,"identity":"722a986d-50f4-442b-b1e9-7acb4d4b1ef6","order_by":6,"name":"Hai Hu","email":"","orcid":"","institution":"1Center for Gallbladder Diseases of Shanghai East Hospital affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hai","middleName":"","lastName":"Hu","suffix":""},{"id":498350926,"identity":"7d3d301d-881f-4c13-ad8e-c58563838672","order_by":7,"name":"Yulong Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYFAC5vYPCRU2YKZBAgMDYwNhLYxtDA/OpEmQpoXxYcthCTiXoBaDG4ltDxIbztfxS7dfKHjAYCO74QDzswcEtLQbJO64LSE550wB0GFpxhsOsJkbENDSIJF45raEwY2cBKCWw4kbDvCwSRDW0nYOpuU/UVragFoOALWkHwBqOUBYi+SZh80GCWeSJWfOyAEGskGy8czDbGZ4tfAdTz748EeFHT+/RPozQyBDtu948zO8WhQuJMCYPGYGDKCgYsanHgjk+w/AmOyPHxBQPApGwSgYBSMUAABf5VOrQIut4gAAAABJRU5ErkJggg==","orcid":"","institution":"1Center for Gallbladder Diseases of Shanghai East Hospital affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Yulong","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2025-05-19 15:23:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6700349/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6700349/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88777227,"identity":"cd78a01f-7a9b-48e6-98db-5cac7237b1e6","added_by":"auto","created_at":"2025-08-11 10:11:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":159294,"visible":true,"origin":"","legend":"\u003cp\u003eAge distribution characteristics of benign gallbladder diseases; a: Gallbladder stones; b: Gallbladder polyps; c: Gallbladder adenomyosis\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6700349/v1/b4be532ede46dfe97ed87cb7.png"},{"id":88772861,"identity":"6c29c1dc-30e4-40cf-8eb6-81313e33b4d3","added_by":"auto","created_at":"2025-08-11 09:55:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":56799,"visible":true,"origin":"","legend":"\u003cp\u003eGender distribution characteristics of benign gallbladder diseases\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6700349/v1/43114132cffffcf5616b2d7e.png"},{"id":88772862,"identity":"b080d394-a702-4d45-a1ad-6ed50371068a","added_by":"auto","created_at":"2025-08-11 09:55:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":62598,"visible":true,"origin":"","legend":"\u003cp\u003eCharacteristics of the intersection between gallbladder stones, gallbladder polyps and gallbladder adenomyosis\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6700349/v1/df9f5d2e6b75b72cc4a3f07d.png"},{"id":88774775,"identity":"1ef61a61-a2ef-40c7-9933-628253db5f8a","added_by":"auto","created_at":"2025-08-11 10:03:20","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":154933,"visible":true,"origin":"","legend":"\u003cp\u003eMenstruation and the risk associated with the development of benign gallbladder disease in women. a: Gallbladder stones; b: Gallbladder polyps; c: Gallbladder adenomyosis\u003c/p\u003e","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-6700349/v1/22b609fad36c2541dc06729b.png"},{"id":88777926,"identity":"68ca7dd0-ce8a-44ee-b314-7616c91b936c","added_by":"auto","created_at":"2025-08-11 10:19:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1635655,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6700349/v1/7f2e9715-4f6c-40af-b449-6909bf1abb8f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Research and analysis on basic clinical characteristics of inpatients with benign gallbladder diseases: a big-data retrospective analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBenign gallbladder diseases are among the most common digestive diseases worldwide, especially in developed and developing countries, and impose a significant economic burden on society. It is reported that about 20\u0026nbsp;million to 25\u0026nbsp;million adults in the United States have gallstones, and the annual medical burden directly or indirectly caused by gallstones is about 6.2\u0026nbsp;billion US dollars\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. In the UK, the financial burden of gallstones on the NHS exceeded 200\u0026nbsp;million pounds in the 2018/19\u003csup\u003e4\u003c/sup\u003e. Benign gallbladder diseases mainly include gallstones, gallbladder polyps and gallbladder adenomyosis. The global prevalence of gallstones is estimated to range from 6–25%\u003csup\u003e4–7\u003c/sup\u003e, that of gallbladder polyps from 0.3–9.5%\u003csup\u003e8–11\u003c/sup\u003e, and that of gallbladder adenomyosis from 2–9%\u003csup\u003e12–14\u003c/sup\u003e. The prevalence of gallstones is higher in women, with a male-to-female ratio of approximately 1:1-3.92\u003csup\u003e1,15,16\u003c/sup\u003e. This difference is mainly related to ethnic factors; gallbladder adenomyosis manifests more frequently in women\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e; and gallbladder polyps are more prevalent in men\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e (male:female = 1.15–1.7:1). The prevalence of gallstones increases significantly after the age of 40, especially in women\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. As individuals age, symptoms often become more subtle, and treatment is often complicated by serious complications, making surgery significantly more difficult. Gallbladder polyps are predominantly observed in individuals between the ages of 40 and 59 years\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e–\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, but their incidence of clinical symptoms is low, and their potential cancer risk cannot be ignored. Gallbladder adenomyosis, like gallbladder polyps, has a low incidence of symptoms, and its cancer risk is mainly related to classification. Segmental adenomyosis has a higher cancer risk, especially in elderly patients\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e .\u003c/p\u003e\u003cp\u003eThe primary risk factors associated with gallstone formation can be classified into two categories: congenital and acquired\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan additionalcitationids=\"CR28 CR29 CR30 CR31 CR32 CR33 CR34\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e–\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Congenital factors include female, advancing age, family history and race. Acquired factors include blood Se, diet, rapid weight loss, obesity, physical activity, drugs and total parenteral nutrition. For example, dyslipidemia, diabetes, metabolic syndrome, and some chronic diseases (such as hemolytic diseases, chronic liver disease, and Crohn's disease) are a combination of congenital and acquired factors. The primary risk factors for gallbladder polyps include male, dyslipidemia, HBsAg positivity, and age\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e (especially middle age). Gallbladder adenomyosis is closely related to gallbladder stones, chronic inflammation of the gallbladder and increased intra-luminal pressure\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e–\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. As can be seen from the above epidemiological characteristics, the risk factors associated with benign gallbladder diseases involve many aspects of life. The combined effect of these factors makes it the most common digestive disease with the highest incidence and medical burden.\u003c/p\u003e\u003cp\u003eThis prompts the question of the treatment concept for benign gallbladder diseases, which is mainly based on the concepts of cholecystectomy and conservative treatment with subsequent follow-up observation. With the advent of minimally invasive surgery, innovations in endoscopic technology have promoted the popularisation of laparoscopic cholecystectomy. At the same time, some scholars have proposed laparoscopic cholecystotomy and stone removal and other surgical methods that preserve the function of the gallbladder based on the concept of precision medicine\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e, which has also greatly increased the number of surgeries for benign gallbladder diseases. The primary risks that increase the difficulty of laparoscopic cholecystectomy are the inflammatory condition of the gallbladder and anatomical abnormalities. The most serious adverse event is bile duct injury\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. In particular, the incidence of gallbladder inflammation is significantly higher than that of anatomical abnormalities. Gallbladder inflammation causes oedema and dense adhesion of the surrounding tissues of the gallbladder, and the anatomical landmarks in the gallbladder triangle cannot be identified, which easily causes bile duct injury. These factors can significantly prolong the patient's hospital stay and increase hospital costs. It is worth noting that these epidemiological characteristics are mainly based on data collected after inpatient treatment, which differs from the epidemiological surveys conducted on large-scale health examination populations.\u003c/p\u003e\u003cp\u003eTherefore, the primary objective of this study is to analyze the clinical characteristics of hospitalized patients with benign gallbladder diseases based on a large dataset, and compare these findings with those from the physical examination population in existing literature.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eResearch methods and subjects\u003c/p\u003e\u003cp\u003eThis is a retrospective big data study that included 36,298 patients with benign gallbladder diseases who underwent treatment at the largest gallstone centre in China from January 2019 to December 2024. The centre treats approximately 6,000 to 8,000 patients with benign gallbladder diseases each year, and has the basic conditions for big data analysis. All benign gallbladder diseases were diagnosed according to the International Classification of Diseases(ICD) codes, including gallstones (K80), gallbladder polyps (K82.802) and gallbladder adenomyosis (K82.803). This study was approved by the Medical Ethics Committee of Dongfang Hospital(No [2022] Review Document No. (107)), Tongji University, Shanghai, China. Therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all participants in this study (Patients under the age of 18 have obtained the informed consent of their legally responsible persons).\u003c/p\u003e\u003cp\u003eDiagnostic criteria: Gallstones, gallbladder polyps and gallbladder adenomyosis were diagnosed based on imaging examinations of the ultrasound, abdominal CT and magnetic resonance cholangiopancreatography (MRCP), combined with the patient's clinical symptoms. The above diseases were diagnosed according to the ‘gold standard’ of pathology after surgery.\u003c/p\u003e\u003cp\u003eInclusion criteria: 1. Gallstone diagnosed according to ICD-10 K80; 2. Gallbladder polyps diagnosed according to ICD-10 K82.802; 3. Gallbladder adenomyosis diagnosed according to ICD-10 K82.803; 4. Patients who received inpatient treatment at this center and had detailed basic demographic information. Exclusion criteria: Basic characteristic information is missing for more than 30% of patients.\u003c/p\u003e\u003cp\u003eData collection\u003c/p\u003e\u003cp\u003eGender, Age, Length of stay, Hypertension, DM, coronary heart disease (CHD), CBDS and Dyslipidaemia (including hypercholesterolaemia, hypertriglycerolaemia and mixed hyperlipidaemia) of all patients were collected from the electronic medical records of hospital information system (HIS). Patients were geographically distributed according to their residential address (Northeast, Eastern, Central, North, Southern, Northwest, Southwest). Gallbladder inflammation is classified into three states of disorder(no inflammation or chronic cholecystitis, acute seizure, perforation of gangrenous origin). Acute seizure includes the following international disease codes K80.000 or K80.002 or K81.000 or K81.002 or K81.006; Perforation of gangrenous origin includes the following international codes: K80.001 or K81.003 or K82.200 or K81.008 or K81.005. Females are divided into menstruation and postmenopausal. Due to system limitations, it is not possible to fully obtain the patient's true menstruation status. According to previous literature reports, females over the age of 50 are classified as post-menopausal after extensive consideration\u003csup\u003e\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e–\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistical analysis was performed on the collected data, summarising the central tendency and dispersion of continuous variables and the frequency and percentage of categorical variables. Comparisons between groups of categorical variables were assessed using Pearson's chi-squared test or Fisher's exact test. Multinomial logistic regression analysis was used to assess risk factors associated with gallbladder inflammation. The variance inflation factor (VIF) was used to diagnose multiple collinearity for the included independent variables, thereby improving the stability and validity of the model. Variables with P \u0026lt; 0.05 in univariate analysis were then included in Multinomial logistic regression analysis. IBM SPSS Statistics version 27 and R version 4.3.0 were used for data analysis. A two-tailed p value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. Basic characteristics of benign gallbladder diseases\u003c/p\u003e\u003cp\u003eThe mean age of patients with gallstones was 50.21\u0026thinsp;\u0026plusmn;\u0026thinsp;15.31 years, gallbladder polyps was 43.90\u0026thinsp;\u0026plusmn;\u0026thinsp;13.53 years and gallbladder adenomyosis was 49.36\u0026thinsp;\u0026plusmn;\u0026thinsp;13.28 years (Table\u0026nbsp;1). Figure\u0026nbsp;1 illustrates the age distribution of benign gallbladder diseases. It is evident that the incidence of gallstones increases steadily after the age of 20 years, peaking between the ages of 30 and 45 years, followed by a slight decrease in growth, and another peak between the ages of 55 and 70 years, after which the trend gradually declines; Gallbladder polyps peak between the ages of 30 and 40 years, with a gradual decline thereafter. Gallbladder adenomyosis generally peaks between the ages of 35 and 65 years, with a gradual decline after the age of 65 years. The overall gender ratio in the gallstone population was approximately 1:1.38(male:female\u0026thinsp;=\u0026thinsp;13175:18304), gallbladder polyps was 1.03:1(male:female\u0026thinsp;=\u0026thinsp;3198:3113) and gallbladder adenomyosis was 1:1.28(male: female\u0026thinsp;=\u0026thinsp;1057:1351) (Table\u0026nbsp;1). Figure\u0026nbsp;2 shows the gender distribution of benign gallbladder diseases. All three types of benign gallbladder diseases were more prevalent in economically developed regions (Eastern China), and the proportion of gallstones with acute seizure (23.9%) was higher than that of other benign gallbladder diseases (Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;1 Basic features of benign gallbladder disease\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGallbladder stones N\u0026thinsp;=\u0026thinsp;31479\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGallbladder polyps N\u0026thinsp;=\u0026thinsp;6311\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGallbladder adenomyosis N\u0026thinsp;=\u0026thinsp;2408\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.21\u0026thinsp;\u0026plusmn;\u0026thinsp;15.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.90\u0026thinsp;\u0026plusmn;\u0026thinsp;13.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.36\u0026thinsp;\u0026plusmn;\u0026thinsp;13.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18304(58.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3113(49.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1351(56.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13175(41.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3198(50.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1057(43.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommon bile duct stones\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e726(2.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(0.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyslipidemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e257(0.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23(1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5094(16.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e632(10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e305(12.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes Mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2052(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e203(3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e101(4.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e965(3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35(1.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNortheast China\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e486(1.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e120(1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45(1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEastern China\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29851(94.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5933(94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2272(94.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral China\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e376(1.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91(1.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth China\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e212(0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouthern China\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64(0.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(0.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(0.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorthwest China\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e161(0.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(0.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(0.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouthwest China\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e201(0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInflammatory state of the gallbladder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo or chronic inflammation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22906(72.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5890(93.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2255(93.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcute seizure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7532(23.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e413(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e148(6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerforation of gangrenous origin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1041(3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(0.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(0.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of hospitalisation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(2,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(2,3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(2,3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e2. Distribution characteristics of benign gallbladder diseases\u003c/p\u003e\u003cp\u003eFigure 3 shows the distribution of benign gallbladder diseases, including 28140 (77.52%) with gallstones only, 3784(10.42%) with gallbladder polyps, and 684(1.88%) with gallbladder adenomyosis; 1966(5.42%) with both gallstones and gallbladder polyps, gallstones and gallbladder adenomyosis 1163(3.2%), gallbladder polyps and gallbladder adenomyosis 351(0.97%); 210(0.58%) had all three of the above-mentioned benign gallbladder diseases simultaneously.\u003c/p\u003e\u003cp\u003e3. The risk of benign gallbladder disease associated with menstruation in women\u003c/p\u003e\u003cp\u003eIn the female subgroup, the risk of benign gallbladder diseases associated with menstruation was analysed. The risk of gallstones in menstruation women was significantly lower than in postmenopausal women(85.28% vs 90.26%, OR: 0.625, 95%CI: 0.575\u0026ndash;0.680, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001); The risk of gallbladder polyps was higher in postmenopausal women(17.66% vs 12.12%, OR: 1.555, 95%CI: 1.439\u0026ndash;1.680, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). There was no significant difference in gallbladder adenomyosis(p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;4).\u003c/p\u003e\u003cp\u003e4. Multinomial-logistic regression analysis of factors to inflammatory state of the gallbladder\u003c/p\u003e\u003cp\u003eThe independent variables of age, gender, gallbladder stones, gallbladder polyps, gallbladder adenomyosis, CBDS, dyslipidemia, hypertension, DM and CHD were included in a linear regression model for multicollinearity diagnosis. It was found that the VIF was less than 5, so multicollinearity between the independent variables was ruled out. Multinomial logistic regression analysis was conducted with the absence of inflammation or chronic cholecystitis in the gallbladder as the reference category. The results showed that age, gender, gallbladder stones, gallbladder polyps, gallbladder adenomyosis, CBDS, hypertension, DM, and CHD were significantly associated with the inflammatory state of the gallbladder (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Compared to individuals aged\u0026thinsp;\u0026le;\u0026thinsp;30 years, those aged\u0026thinsp;\u0026gt;\u0026thinsp;30 years had an increased risk. The risk of acute seizure was higher in individuals aged 45\u0026ndash;60 years(OR: 1.848; 95% CI: 1.618\u0026ndash;2.114, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while the risk of perforation of gangrenous origin was higher in individuals aged 30\u0026ndash;45 years(OR: 3.165; 95% CI: 2.242\u0026ndash;4.464, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); Male had a higher risk of acute seizure(OR: 1.333; 95% CI: 1.265\u0026ndash;1.406, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and perforation of gangrenous origin(OR: 2.196; 95% CI: 1.934\u0026ndash;2.494, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than female; Gallstones were associated with a higher risk of acute seizure(OR: 2.857; 95% CI: 2.370\u0026ndash;3.436, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); Gallbladder polyps and gallbladder adenomyosis were associated with a lower risk of acute seizure or perforation of gangrenous origin(both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); CBDS were associated with a higher risk of acute seizure(OR: 2.024; 95% CI: 1.727\u0026ndash;2.370, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and perforation of gangrenous origin(OR: 2.481; 95% CI: 1.848\u0026ndash;3.333, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001);DM was associated with a higher risk of acute seizure(OR: 1.316; 95% CI: 1.183\u0026ndash;1.462, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and perforation of gangrenous origin(OR: 1.773; 95% CI: 1.425\u0026ndash;2.208, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); Hypertension was associated with a higher risk of acute seizure(OR: 1.304; 95%CI: 1.209\u0026ndash;1.406, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); CHD was associated with a higher risk of acute seizure(OR: 1.328; 95%CI: 1.149\u0026ndash;1.534, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultinomial-logistic regression analysis of factors to inflammatory state of the gallbladder\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eAcute seizure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e\u003cp\u003ePerforation of gangrenous origin\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR(95%Cl)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOR(95%Cl)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e≦\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30,≦ 45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.598\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.818(1.563\u0026ndash;2.119)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.165(2.242\u0026ndash;4.464)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;45,≦ 60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.848(1.618\u0026ndash;2.114)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.797\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.217(1.695\u0026ndash;2.907)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;60,≦ 75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.530\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.698(1.488\u0026ndash;1.938)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.982\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.667(2.041\u0026ndash;3.497)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.435(1.259\u0026ndash;1.631)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.555\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.742(1.351\u0026ndash;2.247)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.333(1.265\u0026ndash;1.406)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.196(1.934\u0026ndash;2.494)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGallbladder polyps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.392(0.344\u0026ndash;0.448)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-2.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.085(0.042\u0026ndash;0.171)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGallbladder adenomyosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.304(0.256\u0026ndash;0.362)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-2.355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.095(0.039\u0026ndash;0.229)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGallbladder stones\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.857(2.370\u0026ndash;3.436)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommon bile duct stones\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.024(1.727\u0026ndash;2.370)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.909\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.481(1.848\u0026ndash;3.333)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyslipidemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.238(0.946\u0026ndash;1.621)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.333\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.085(0.564\u0026ndash;2.083)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.922\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.304(1.209\u0026ndash;1.406)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.031(0.861\u0026ndash;1.233)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.742\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes Mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.274\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.316(1.183\u0026ndash;1.462)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.572\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.773(1.425\u0026ndash;2.208)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.328(1.149\u0026ndash;1.534)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.970(0.700-1.344)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.856\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is one of the largest clinical studies on inpatients with benign gallbladder diseases. Unlike previous studies based on large-scale physical examination populations, this study found that among inpatients with benign gallbladder diseases, the proportion of those with gallstones was as high as 86.72%, gallbladder polyps 17.39%, and gallbladder adenomyosis 5.66%. The main reason is that the movability of gallstones, with the contraction of the gallbladder and changes in body position, the stones can easily become lodged in the neck of the gallbladder or the cystic duct, which in turn can trigger typical clinical symptoms, or damage gallbladder function through chronic inflammation and irritation over the long term, leading to nonspecific manifestations. Therefore, compared to gallbladder polyps and gallbladder adenomyosis, which have a lower incidence of clinical symptoms, gallstone disease requires hospitalization in significantly more patients. This study found that the incidence of gallstones combined with gallbladder polyps was 6%, which is similar to the 0.25%-6.5% reported in the literature\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, and also describes the overlapping characteristics of these three diseases. Further analysis revealed that the prevalence of gallstones showed two peaks in the age distribution, one between 30 and 45 years and another between 55 and 70 years, followed by a gradual decline. This may be due to the fact that as people get older, their perception of symptoms decreases and they become less sensitive to symptoms. The proportion of patients requiring inpatient treatment begins to decrease. However, it should be noted that while symptoms can be subtle, when they occur, they often result in more serious complications. In contrast to this study and previous research, a study that included 438 cases of gallbladder polyps and followed them up for 6 years found that the incidence of gallbladder polyps was higher in middle-aged women\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e (female:male\u0026thinsp;=\u0026thinsp;1.44:1), which may be due to differences in sample size. Overall, the age and gender distribution characteristics of gallstones, gallbladder polyps and gallbladder adenomyosis are similar to previous studies\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIt is well known that women are one of the main risk factors for gallstones, which is closely related to their sex hormone levels, number of births, use of oral contraceptives, and estrogen replacement therapy\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e,\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. During pregnancy in particular, 5\u0026ndash;30% of women will develop microstones or sludge in the gallbladder\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e,\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e, but most of these will gradually disappear after pregnancy. This gender gap gradually narrows after menopause. Further research found that the risk of gallstones in menstruation women was 0.625 times that of postmenopausal women (95% CI: 0.575\u0026ndash;0.680, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). These results differ significantly from those of other studies\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. In this study, postmenopausal women did not receive estrogen replacement therapy, but the incidence of gallstones was 1.6 times that of menstruating women. There are two possible reasons for this phenomenon: First, the significant decline in estrogen levels in postmenopausal women leads to abnormal lipid metabolis, which in turn causes abnormalities in the bile microenvironment in the gallbladder, bile stasis, and cholesterol supersaturation\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e. Second, as individuals age, the contractile function of the gallbladder naturally declines. This study focused on the inflammatory state of the gallbladder and performed a multinomial logistic regression analysis, and found that age, male, gallstones, CBDS, hypertension, CHD and DM were significantly associated with the inflammatory state of the gallbladder (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Age 45\u0026ndash;60 years(OR: 1.848; 95%CI: 1.618\u0026ndash;2.114, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), gallbladder stones(OR: 2.857; 95%CI: 2.370\u0026ndash;3.436, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and CBDS(OR: 2.024; 95%CI: 1.727\u0026ndash;2.370, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were associated with a higher risk of acute seizure; Additionally, age 30\u0026ndash;45 years(OR : 3.165; 95%CI: 2.242\u0026ndash;4.464, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), male(OR: 2.196; 95%CI: 1.934\u0026ndash;2.494, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the presence of CBDS(OR: 2.481; 95%CI: 1.848\u0026ndash;3.333, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were associated with a higher risk of gallbladder perforation of gangrenous origin. When managing patients with benign gallbladder diseases, special attention should be given to the above-mentioned characteristic populations, and careful examinations should be performed. During surgery, the aim should be to remove the lesion as much as possible, rather than completely resecting the gallbladder radically, in order to minimise the difficulty of the operation and avoid bile duct injury\u003c/p\u003e\u003cp\u003eA big data study of inpatients with benign gallbladder disease has the potential to contribute to two key areas of research. Firstly, it can provide valuable epidemiological information on the population of inpatients. Secondly, it can further refine clinical management strategies for the disease. Benign gallbladder diseases is one of the most economically burdensome diseases in the digestive system. It has a high incidence rate and there are also differences in treatment concepts. In clinical practice, some patients frequently visit the doctor for different opinions provided by different doctors. This can cause significant anxiety for patients and also result in a considerable waste of medical resources. The root cause is that doctors differ in their judgments as to whether intervention is necessary. By conducting a large data survey of inpatients with benign gallbladder diseases, high-risk patients can be identified early, so that early diagnosis and treatment can be achieved, the occurrence of complications can be reduced, and bile duct damage caused by increased surgical difficulty due to delayed treatment can be avoided. Based on the concept of precision medicine in modern medicine and artificial intelligence big data models, individualized treatment combined with prevention can better achieve precision treatment and avoid wasting medical resources.\u003c/p\u003e\u003cp\u003eIn summary, gallstones are the main cause of hospitalization for benign gallbladder diseases, and the risk is higher in postmenopausal women. Middle age, male, gallstones, CBDS and DM are risk factors for inflammatory reactions in the gallbladder. The basic clinical characteristics of patients with gallbladder polyps and gallbladder adenomyosis are similar to those of healthy people.\u003c/p\u003e\u003cp\u003eThis study still has limitations. Due to medical data restrictions, most details of the hospitalised patients with these benign gallbladder diseases, including body mass index, true menstruation status, clinical manifestations, blood lipid levels, liver function and inflammatory indicators, were not fully obtained. Consequently, a comparison with the local health examination population from the same period could not be made, and the study could only be compared with previous large-scale epidemiological studies of benign gallbladder diseases.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCBDS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCommon Bile Duct Stones\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDiabetes Mellitus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited States\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUK\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited Kingdom\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNHS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Health Service\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Classification of Diseases\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMRCP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMagnetic Resonance Cholangiopancreatography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCHD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCoronary Heart Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHIS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHospital Information System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVIF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVariance Inflation Factor.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Medical Ethics Committee of Dongfang Hospital(No [2022] Review Document No. (107)), Tongji University, Shanghai, China. Therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all participants in this study (Patients under the age of 18 have obtained the informed consent of their legally responsible persons).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analysed during the current study are not publicly available due this study involves private information of the participating patients and in accordance with hospital regulations, disclosure of any patient information is strictly prohibited. but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eKey Specialty Construction Project of Shanghai Pudong New Area Health Commission (PWZzk2022-17); The Featured Clinical Discipline Project of Shanghai Pudong (PWYts2021-06); Clinical Research Project of Shanghai East Hospital (DFLC2022019)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eAll authors contributed to the study conception and design. Honglei Zhang: conceptualization, methodology, writing the manuscript and reviewing the references; Cheng Zhang, Chen Qiu and Yukai Xiang: collecting the data and performing the experiments; Chen Qiu and Yukai Xiang: data organization and analysis; Honglei Zhang and Cheng Zhang: integrating the pictures and making the tables. Zhaoyan Jiang and Liang Zheng: critically reviewed the study proposal and technical editing of the manuscript. Yulong Yang and Hai Hu: conceptualization, methodology, supervising the research and revising the manuscript. The first draft of the manuscript was written by Honglei Zhang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe thank all authors who participated in this study for their contributions and for funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. \u003cem\u003eGut Liver\u003c/em\u003e 2012; \u003cstrong\u003e6\u003c/strong\u003e(2): 172-87.\u003c/li\u003e\n\u003cli\u003eSandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. \u003cem\u003eGastroenterology\u003c/em\u003e 2002; \u003cstrong\u003e122\u003c/strong\u003e(5): 1500-11.\u003c/li\u003e\n\u003cli\u003eEverhart JE, Ruhl CE. 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Estrogen and the cardiovascular system. \u003cem\u003ePharmacol Ther\u003c/em\u003e 2012; \u003cstrong\u003e135\u003c/strong\u003e(1): 54-70.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"gallbladder stones, gallbladder polyps, gallbladder adenomyosis, gallbladder inflammation","lastPublishedDoi":"10.21203/rs.3.rs-6700349/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6700349/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo analyze the clinical characteristics of hospitalized patients with benign gallbladder diseases based on a large dataset, and compare these findings with those from the physical examination population in existing literature.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 36,298 patients admitted to the gallstone center of a tertiary hospital in Shanghai between 2019 and 2024 for benign gallbladder diseases were included in the study. Basic patient information was collected from the electronic medical records system in accordance with the international classification of diseases. Descriptive statistics and Multinomial logistic regression methods were employed to analyze the clinical characteristics of patients and identify risk factors associated with gallbladder inflammatory conditions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean age of patients with gallstones was 50.21\u0026thinsp;\u0026plusmn;\u0026thinsp;15.31 years, 43.90\u0026thinsp;\u0026plusmn;\u0026thinsp;13.53 years for gallbladder polyps, and 49.36\u0026thinsp;\u0026plusmn;\u0026thinsp;13.28 years for gallbladder adenomyosis. The overall gender ratio in the gallstone population was approximately 1:1.38(male:female\u0026thinsp;=\u0026thinsp;13175:18304), gallbladder polyps was 1.03:1(male:female\u0026thinsp;=\u0026thinsp;3198:3113) and gallbladder adenomyosis was 1:1.28(male:female\u0026thinsp;=\u0026thinsp;1057:1351); the risk of gallbladder stones in menstruation women is 0.625 times that in postmenopausal (95% CI: 0.575\u0026ndash;0.680, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and gallbladder polyps were 1.555 times(95% CI: 1.439\u0026ndash;1.680, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Multinomial logistic regression analysis demonstrated that age, male, gallstones, common bile duct stones(CBDS) and diabetes mellitus(DM) were significantly associated with the inflammatory state of the gallbladder(all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eGallstones is the primary cause of hospitalisation for benign gallbladder disease, and the risk is higher in postmenopausal women. Middle age, male, gallstones, CBDS and DM are identified as risk factors for gallbladder inflammation. The clinical characteristics of patients with gallbladder polyps and adenomyosis are similar to those reported in the general population in existing literature\u003c/p\u003e","manuscriptTitle":"Research and analysis on basic clinical characteristics of inpatients with benign gallbladder diseases: a big-data retrospective analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 09:55:16","doi":"10.21203/rs.3.rs-6700349/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-11T06:24:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-10T08:36:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250985104023604695757099369073354544502","date":"2025-08-10T08:30:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-09T20:36:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78897670715236449363569897070810338244","date":"2025-08-06T10:46:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-01T15:22:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-08T07:28:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-23T08:05:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-22T13:03:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-05-22T13:01:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce6180a4-7167-4cb5-ae13-e14dbf2b78db","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-25T15:08:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-11 09:55:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6700349","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6700349","identity":"rs-6700349","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}