El-Serag H B, Sonnenberg A
Department of Veterans Affairs Medical Center and The University of New Mexico, Albuquerque 87108, USA.
J Clin Gastroenterol. 1999 Mar;28(2):135-9. doi: 10.1097/00004836-199903000-00010.
Cancers of the esophagus, gastroesophageal junction (including the gastric cardia), and stomach represent three separate diseases with marked epidemiologic variations. The Department of Veterans Affairs computerized database records the ethnicity of all hospitalized patients throughout the United States, which provides an opportunity to study the influence of ethnicity on cancer rates in a uniform health-care system. All hospitalized patients, from 1980 through 1995, with a diagnosis of upper gastrointestinal cancer were identified. For each ethnic group and cancer type, hospitalization was expressed as an age-adjusted proportional rate per 10,000 hospitalizations from all causes. Hospitalization with gastric cancer was most frequent among Asians (48.4 per 10,000 hospitalizations) followed by blacks (33.3), Hispanics (28.7), American Indians (20.3), and whites (12.0). Adenocarcinoma of the gastroesophageal junction accounted for 5.9 per 10,000 hospitalizations among Asians, 4.5 among whites, and 4.5 among Hispanics. Gastroesophageal junction cancer was lowest among blacks (2.9) and American Indians (2.4). Finally, squamous cell carcinoma of the esophagus was frequent among blacks, 68.2 per 10,000, followed by Hispanics (36.4) and Asians (27.8), and was low among whites 24.0 and American Indians (21.5). Esophageal cancer rates remained stable in all ethnic groups from 1980 through 1995; gastroesophageal junction cancer rates increased particularly among whites, whereas gastric cancer rates declined in whites and blacks but not in Hispanics. There were significant ethnic differences in the occurrence of gastroesophageal malignancies among US military veterans. Environmental factors may explain some of these differences. Differential rates of Helicobacter pylori infection with resultant gastric atrophy and reduced acid output led to a greater risk for gastric cancer, but a reduced risk for reflux disease and cardiac cancer.
食管癌、胃食管交界癌（包括贲门癌）和胃癌是三种不同的疾病，在流行病学上存在显著差异。美国退伍军人事务部的计算机化数据库记录了全美国所有住院患者的种族信息，这为在统一的医疗保健系统中研究种族对癌症发病率的影响提供了契机。确定了1980年至1995年期间所有诊断为上消化道癌症的住院患者。对于每个种族群体和癌症类型，住院率以每10000例全因住院的年龄调整比例率表示。胃癌住院率在亚洲人中最高（每10000例住院中有48.4例），其次是黑人（33.3例）、西班牙裔（28.7例）、美国印第安人（20.3例）和白人（12.0例）。胃食管交界腺癌在亚洲人中每10000例住院中有5.9例，在白人中为4.5例，在西班牙裔中为4.5例。胃食管交界癌在黑人（2.9例）和美国印第安人（2.4例）中最低。最后，食管癌鳞状细胞癌在黑人中很常见，每10000例中有68.2例，其次是西班牙裔（36.4例）和亚洲人（27.8例），在白人和美国印第安人中较低（分别为24.0例和21.5例）。1980年至1995年期间，所有种族群体的食管癌发病率保持稳定；胃食管交界癌发病率尤其在白人中有所上升，而胃癌发病率在白人和黑人中下降，但在西班牙裔中没有下降。在美国退伍军人中，胃食管恶性肿瘤的发生存在显著的种族差异。环境因素可能解释了其中一些差异。幽门螺杆菌感染导致胃萎缩和胃酸分泌减少的不同发生率，导致患胃癌的风险增加，但患反流性疾病和贲门癌的风险降低。
