Background <p>Gallstone disease is a common clinical condition worldwide, with a global incidence ranging from less than 10% to over 40% and affecting approximately 3–11% of the population in China. This high and increasing prevalence places a significant burden on healthcare resources due to the costs associated with diagnosis, treatment, and long-term follow-up. More importantly, gallstones can lead to severe complications, such as acute cholecystitis, cholangitis, and pancreatitis, establishing the disease as a major public health concern. Although traditionally associated with a higher incidence in middle-aged women, the number of elderly patients with gallstones is rising as Chinese society ages. However, large-scale epidemiological studies covering the entire adult age spectrum and explicitly exploring the relationship between age and gallstone incidence remain scarce. Furthermore, while numerous studies have investigated risk factors for gallstone formation, few have examined the dynamic changes in individual-level data before and after stone formation—an approach that could offer more valuable insights for personalized prevention. Therefore, this study aims to address these gaps through a retrospective analysis of 10 years of health examination data, to explore the incidence trend and preventable risk factors for gallstones, and ultimately to provide a basis for improving clinical management and prevention strategies.</p> Methods <p>Through the retrospective analysis from January 2012 to December 2021 in Xuanwu Hospital, Capital Medical University physical examination center for health examination related data, select those who have no gallstones on baseline data and receive two or more ultrasound examinations. A total of 37,440 subjects were included in the study, Age (44.48 ± 16.06) (range 16–103 years). Gallstones were confirmed by repeated ultrasound examinations. Then, according to the data before and after the formation of gallstones, the subjects were divided into study group and control group. Rank-sum test and χ2 test were used to analyze the data statistically and explored the risk factors for gallstone formation by Logistic regression analysis. Results: 1401 subjects were confirmed the gallstones, 699 men, 702 women, age (59.57 ± 16.12) years (range: 22–103 years old), and the incidence of gallstones was 3.73%. The incidence of gallstones in the elderly aged 65 years and above was significantly higher than that in the young and middle-aged group below 65 [11.88% (553 / 4653): 2.59% (848 / 32788)], and the difference was statistically significant (χ2 = 3183.17, <i>P</i> &lt; 0.001), the incidence of gallstones in men and women increased with age. The incidence was lower in women than in men before age 30. After age 30, it is more common in female than in male. Multivariate logistic-analysis found statistically significant differences in age, waist circumference, aspartate aminotransferase, fasting blood glucose, triglycerides, and high-density lipoprotein.</p> Conclusion <p>The incidence of gallstones in the elderly aged 65 years and above is significantly higher than that in the young and middle-aged people. The incidence of gallstones increases with age, the older the age, the higher the incidence of gallstones, as was seen in both men and women. Age, waist circumference, aspartate aminotransferase and fasting blood glucose are risk factors for gallstone formation, triglycerides and high-density lipoprotein are protective factors for gallstone formation.</p>