Background: Gallbladder cancer  GBC  is a rare tumor that often presents at an advanced stage and is associated ith a poor prognosis. Little is knon about the incidence patterns and factors that influence outcomes in GBC. Methods: GBC cases diagnosed beteen 1973 and 2012 ere identified using Surveillance, Epidemiology and End Results  SEER  database and annual percent change  APC  in the incidence rates ere calculated for the same time period. A retrospective cohort of 16547 GBC patients diagnosed from 1973 to 2008 as further analyzed using Chi-square test and Cox proportional hazards model. Results: While the overall incidence of GBC decreased over last four decades, a significant increase as observed among Blacks  Table . Subsets of population belonging to Hispanic origin and other ethnicities  including American Indians  had a significant decrease in GBC incidence. 5-year overall survival  OS  and disease specific survival  DSS  ere 12.8 percent and 11.7 percent, respectively. Poor prognostic factors included age lt 50 years  HR 1.115  and male gender  HR 1.082 . Other multi-level variables ith poor prognosis included lack of high school education, and higher grade and stage at diagnosis  plt0.0001 . On the other hand, marital status, Hispanic ethnicity, higher income level and treatment ere associated ith better OS and DSS  plt0.005 . Conclusions: Our analysis suggests an overall decrease in incidence of GBC ith a significant decrease among Hispanics and American Indians, possibly due to increasing early cholecystectomy rates. Hoever, the incidence rates of GBC seem to be increasing among Blacks. Furthermore, younger age at diagnosis as associated ith poor outcomes. Additional studies are required to validate these findings and understand the molecular basis for this heterogeneity in outcomes. YearAll patientsMaleFemalex2264;39 yrs40-64 yrs65 yrsWhiteBlackOtherHispanic originNon-Hispanic origin1973-1991-2x002A;-2x002A;-1.9x002A;0-1.3x002A;-2.3x002A;-2.2x002A;-0.5-1.9x002A;--1992-1999-2.2x002A;-0.6-2.6x002A;-1.7-3.5-1.3-2.3x002A;3.7-1.2-3.8-1.82000-2012-0.10.4-0.20.11.4x002A;-0.302.4x002A;-4-2.1x002A;0.4ltfn id=TF-162022-001-1 ltp class=mtgabstract-table-fn x002A;APC is significant  plt0.05 .lttable-rap-foot ,J Clin Oncol 34, 2016  suppl; abstr e15583 ,Publication Only Gastrointestinal  Noncolorectal  Cancer