美国胃癌临床表现和筛查实践中的种族差异：1997-2010 年监测、流行病学和最终结果-医疗保险数据的分析。
Ethnic Disparities in Gastric Cancer Presentation and Screening Practice in the United States: Analysis of 1997-2010 Surveillance, Epidemiology, and End Results-Medicare Data.
机构信息
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.
Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California.
出版信息
Cancer Epidemiol Biomarkers Prev. 2019 Apr;28(4):659-665. doi: 10.1158/1055-9965.EPI-18-0471. Epub 2019 Mar 26.
BACKGROUND
Chronic infection with () is the strongest risk factor for distal gastric cancer. Although gastric cancer incidence has decreased, variation by race and ethnicity is observed. This study describes gastric cancer presentation and screening services among Medicare patients by race/ethnicity, place of birth, and history of gastric cancer-related conditions.
METHODS
Using demographic, location, and disease staging information, extracted from the Surveillance, Epidemiology and End Results-Medicare gastric cancer database (1997-2010), we compared frequencies of gastric cancer-related conditions (e.g., peptic ulcer, gastric ulcer, gastritis) and screening ( testing and endoscopy) from inpatient and outpatient services claims by selected race/ethnicity and place of birth.
RESULTS
Data included 47,994 incident gastric cancer cases with Medicare claims. The majority (48.0%) of Asian/Pacific Islanders (API) were foreign-born, compared with non-Hispanic whites (NHW), Hispanics, and blacks (with 64.4%, 33.9%, and 72.9% U.S.-born, respectively). For NHWs, the most frequently diagnosed gastric cancer site was the cardia (35.6%) compared with <15% ( < 0.001) for APIs, Hispanics, and blacks. Although more than 57% of all cases had a history of gastric cancer-related conditions, testing was reported in only 11.6% of those cases. testing was highest for APIs (22.8%) and lowest for blacks (6.5%).
CONCLUSIONS
Noncardia gastric cancer, associated with infection, was diagnosed more frequently among APIs, blacks, and Hispanics than NHWs. Testing for was low among all gastric cancer cases despite evidence of risk factors for which screening is recommended. Studies are needed to increase appropriate testing for among higher risk populations.
IMPACT
This study sheds light on poor screening practices despite presence of gastric cancer-related conditions.
背景
（）的慢性感染是远端胃癌的最强危险因素。尽管胃癌的发病率有所下降，但仍存在种族和民族差异。本研究描述了医疗保险患者的胃癌表现和筛查服务，按种族/族裔、出生地和胃癌相关疾病史进行分类。
方法
我们从监测、流行病学和最终结果-医疗保险胃癌数据库（1997-2010 年）中提取人口统计学、位置和疾病分期信息，比较了特定种族/族裔和出生地的住院和门诊服务索赔中与胃癌相关的疾病（例如消化性溃疡、胃溃疡、胃炎）和筛查（测试和内窥镜检查）的频率。
结果
数据包括 47994 例有医疗保险索赔的胃癌新发病例。大多数（48.0%）亚洲/太平洋岛民（API）是外国出生的，而非西班牙裔白人（NHW）、西班牙裔和黑人则分别为 64.4%、33.9%和 72.9%。对于 NHW，最常诊断的胃癌部位是贲门（35.6%），而 API、西班牙裔和黑人则不到 15%（<0.001）。尽管超过 57%的病例有胃癌相关疾病史，但仅有 11.6%的病例报告了测试。API 的测试率最高（22.8%），黑人最低（6.5%）。
结论
非贲门胃癌与感染有关，在 API、黑人和西班牙裔中比 NHW 更常被诊断。尽管有推荐筛查的危险因素，但所有胃癌病例的测试率都很低。需要进行研究以增加对高危人群的适当测试。
影响
本研究揭示了尽管存在胃癌相关疾病，但筛查实践仍很差。
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