Gilbert's syndrome and the risk of death: a population-based cohort study

J Gastroenterol Hepatol. 2013 Oct;28(10):1643-7. doi: 10.1111/jgh.12279.


Background and aims: Gilbert's syndrome is a common familial hyperbilirubinemia that may reduce the risk of various age-related diseases because of the antioxidant properties of bilirubin. We conducted a large cohort study using The Health Improvement Network primary care database and compared all-cause mortality rates in those with and without Gilbert's syndrome.

Methods: Mortality rates in patients with a diagnosis of Gilbert's syndrome and raised bilirubin level (n = 4266) were compared with those of patients with similar characteristics but with normal bilirubin levels (n = 21 968). Multivariate Poisson regression was also used to estimate adjusted mortality rate ratios.

Results: During the 350 000 PYs of follow up across the Gilbert's and comparison cohorts, there were 1174 deaths. Mortality rates were 24/10 000 PYs in the Gilbert's cohort versus 50/10 000 PYs in the comparison cohort. Mortality rates were around half in patients with Gilbert's syndrome after accounting for sociodemographics and general health indicators (adjusted mortality rate ratio: 0.5 [95% confidence interval; 0.4-0.7; P < 0.001]).

Conclusions: Mortality rates observed for people with Gilbert's syndrome in the general population are almost half those of people without evidence of Gilbert's syndrome.

Keywords: Gilbert disease; bilirubin; bilirubin uridine-diphosphoglucuronosyl transferase 1A1; cohort; database; mortality.

MeSH terms

  • Adult
  • Antioxidants
  • Bilirubin / blood
  • Cause of Death
  • Cohort Studies
  • Female
  • Gilbert Disease / genetics
  • Gilbert Disease / mortality*
  • Glucuronosyltransferase / deficiency
  • Health Status Indicators
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Regression Analysis
  • Risk
  • United Kingdom / epidemiology


  • Antioxidants
  • UGT1A1 enzyme
  • Glucuronosyltransferase
  • Bilirubin