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High Rates of Gallbladder Cancer in New Zealand Maori: An Interplay of Disease and Social Factors
Jonathan Koea, Auckland Hospital, Auckland, Auckland, New Zealand; Andrew Sporle, University of Auckland, Auckland, Auckland, New Zealand

Introduction. Carcinoma of the gallbladder (GBC) is a rare cancer which has a defined geographical distribution with the highest incidence observed in South America and Asia. The indigenous population of New Zealand (NZMaori) also has an elevated rate of GBC for reasons that are unclear.

Methods. Diagnostic and procedural data for NZ Maori, Pacific Islanders and European New Zealanders was obtained from the National Cancer Registry of New Zealand for 1988 – 2001 inclusive. Data were stratified for ethnicity, admission rate with gallstone related disease (biliary colic, cholecystitis, choledocolithiasis, cholangitis and pancreatitis), admissions with sepsis (cholecystitis, cholangitis and pancreatitis), and procedure (laparoscopic or open cholecystectomy. National census statistics were used to calculate age standardized incidence rates. Results. Between 1988 and 2001 the age standardized rates for GBC in Europeans was 0.36/100,000 in men and 0.70/100,000 in women; and 0.32/100,000 in Pacific Island men, 0.76/100,000 in Pacific Island women. In the same period the age standardized rates for GBC in NZMaori were 1.49/100,000 in men and 1.59/100,000 in women with NZMaori having 3.5 times the relative risk of non-Maori in developing GBC (95% Confidence Interval; 2.1-5.0).

	Admission Rate	% Admissions with Sepsis	Cholecystectomy Rate
NZMaori	27/100,000	62%	5/100,000
Pacific	33/100,000	68%	23/100,000
European	22/100,000	37%	31/100,000

NZMaori were nearly twice as likely to be managed with an open cholecystectomy than Pacific or European patients (relative risk 1.65; 95% confidence interval 1.41-1.89). Conclusions. The high rates of GBC observed in Maori reflect a high incidence of gallstone related disease and a low rate of cholecystectomy. Maori are more likely to be hospitalised with septic complications related to gallstone disease and more likely to be managed with open cholecystectomy.

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