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To assess how obstructive jaundice and socioeconomic determinants (residence, literacy, gender) affect treatment initiation and curative surgical eligibility among patients with gallbladder cancer in North India.

In this prospective observational cohort, adults with radiological or histological gallbladder cancer presenting between September 2023 and May 2024 were enrolled at a tertiary cancer centre. Baseline demographics, stage, obstructive jaundice status, biliary drainage (PTBD/ERCP), treatment initiation, and surgical eligibility were recorded. Associations were examined using chi-square and relative risk, followed by multivariable logistic regression including variables with p < 0.10.

Of 1,500 enrolled patients, 1,409 were evaluable; 643 (45.6%) had obstructive jaundice. Treatment non-initiation occurred in 330/643 (51.3%) with obstructive jaundice versus 24/766 (3.1%) without obstructive jaundice (p < 0.001). Curative surgery was feasible in 51/643 (7.9%) with obstructive jaundice compared with 223/766 (29.1%) without obstructive jaundice (RR 0.27; 95% CI 0.20-0.36). Illiteracy (57.6%) and rural residence (69.4%) predominated. On multivariable analysis, independent predictors of treatment non-initiation were obstructive jaundice (aOR 11.2; 95% CI 7.6-16.5), metastatic disease at presentation (aOR 3.9; 95% CI 2.1-7.4), rural residence (aOR 2.7; 95% CI 1.9-3.9), and illiteracy (aOR 1.8; 95% CI 1.3-2.6).

Obstructive jaundice and socioeconomic disadvantage synergistically drive early care discontinuity and reduce curative opportunities in gallbladder cancer, supporting decentralized decompression, patient navigation, and socioeconomic support in high-incidence regions.