A new study has determined that gallbladder disease is associated with age and disease severity, but not sex, in children with sickle cell disease (SCD).

The study, published in Pediatric Blood & Cancer, also found that neither age nor sex were associated with the rate of cholecystectomy in pediatric patients with both SCD and gallbladder disease.

The research team conducted a longitudinal retrospective cohort study on 13,745 children and young adults with SCD between January 1, 2014, and December 31, 2018, with a median follow-up time of 3 years. Data on demographics, diagnosis codes, and procedure codes from ambulatory and inpatient services, as well as outpatient prescription dates and quantities, were analyzed.

“We had three specific hypotheses,” the authors wrote. “(1) There would be a significant positive correlation between age and [gallbladder disease]/cholecystectomy with higher rates of [gallbladder disease] in older children; (2) female sex would be an effect modifier of the relationship between age and [gallbladder disease] with increased [gallbladder disease] prevalence in females compared with males after the onset of puberty (age 13+ years); and (3) children with higher clinical disease severity would have a higher rate of [gallbladder disease] than children with lower clinical disease severity.”

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The results revealed a significant association between age and gallbladder disease, with gallbladder disease increasing in a nonlinear fashion as age increased. Although gallbladder disease rates increased with age, cholecystectomy rates did not, suggesting that cholecystectomy is routinely recommended by clinicians for children with SCD.

Although there was a trend towards a higher rate of gallstones in female patients with SCD compared to male patients, it was not significant. Lastly, greater disease severity and more exposure to hydroxyurea were associated with a higher risk of gallbladder disease.

The authors recommend additional longitudinal studies on risk factors for gallbladder disease complications in children with SCD and whether hydroxyurea, initiated early, could prevent gallbladder disease in these patients.


Agawu A, Shults J, Smith-Whitley K, Feudtner C. Age- and sex-specific rates of gall bladder disease in children with sickle cell disease. Pediatr Blood Cancer. Published online August 23, 2022. doi:10.1002/pbc.29863