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[17] [18] Additional risk factors include: Female sex and pregnancy history : Women, particularly those who have been pregnant, have higher baseline gallstone risk Age over 40 years : Gallbladder disease incidence increases with age Obesity : Higher BMI correlates with increased gallstone prevalence Diabetes : Type 2 diabetes itself is associated with gallbladder dysfunction Rapid weight cycling : History of repeated weight loss and regain Certain ethnicities : Native American and Hispanic populations have higher gallstone rates [23] [24] Family history : Genetic predisposition to gallbladder disease Estrogen therapy : May increase cholesterol saturation in bile Patients with multiple risk factors should engage in thorough discussion with their healthcare provider about symptom awareness