Department of Population Health Sciences, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Mays Cancer Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Cancer Med. 2021 Sep;10(18):6468-6479. doi: 10.1002/cam4.4175. Epub 2021 Aug 19.
Gastric cancer disproportionately affects Latinos, but little is known about regional effects and risk factors. We compared primary incidence, late-stage diagnosis, and risk factors for gastric adenocarcinoma (GCA) from 2004 to 2016 in Latinos and non-Latinos in the United States, Texas (TX), and South Texas (STX).
We collected case data from Surveillance, Epidemiology, and End Results (SEER) and the Texas Cancer Registry. We generated average annual age-adjusted incidence rates, rate ratios (RRs), and 95% confidence intervals (CIs) using SEER*Stat software and analyzed the cases by anatomic site, demographics, and county-level risk factors using SAS 9.4. We constructed multilevel logistic regression models for late-stage GCA, adjusting for patient- and county-level characteristics.
Latinos had higher overall GCA incidence rates in all regions, with the greatest disparities in overlap GCA in STX males (RR 4.39; 95% CI: 2.85, 6.93). There were no differences in cardia GCA rates for non-Hispanic Whites (NHWs) and Latino women in all regions. Younger patients, patients with overlapping or not otherwise specified (NOS) lesions, and patients diagnosed during 2012-2016 had higher odds of late-stage GCA. The stratification by location showed no differences in late-stage disease between NHWs and Latinos. The stratification by anatomic site showed Latinos with cardia GCA were more likely to have late-stage GCA than NHWs (OR: 1.13, p = 0.008). At the county level, higher odds of late-stage GCA were associated with medium and high social deprivation levels in TX without STX (OR: 1.25 and 1.20, p = 0.007 and 0.028, respectively), and medium social deprivation index (SDI) in patients with NOS GCA (OR: 1.21, p = 0.01).
STX Latinos experience greater GCA disparities than those in TX and the United States. Younger age and social deprivation increase the risk for late-stage GCA, while Latinos and women are at higher risk specifically for late-stage cardia GCA. There is a need for population-specific, culturally responsive intervention and prevention measures, and additional research to elucidate contributing risk factors.
胃癌在拉丁裔人群中的发病率不成比例，但对于其区域性影响和风险因素知之甚少。我们比较了 2004 年至 2016 年期间美国、德克萨斯州（TX）和南德克萨斯州（STX）的拉丁裔和非拉丁裔人群中胃腺癌（GCA）的原发性发病、晚期诊断和风险因素。
我们从监测、流行病学和最终结果（SEER）和德克萨斯癌症登记处收集病例数据。我们使用 SEER*Stat 软件生成平均年度年龄调整发病率、比率比（RR）和 95%置信区间（CI），并使用 SAS 9.4 按解剖部位、人口统计学和县级风险因素对病例进行分析。我们构建了晚期 GCA 的多水平逻辑回归模型，调整了患者和县级特征。
在所有地区，拉丁裔人群的总体 GCA 发病率均较高，STX 男性重叠 GCA 的差异最大（RR 4.39；95%CI：2.85，6.93）。在所有地区，非西班牙裔白人和拉丁裔女性的贲门 GCA 发病率均无差异。较年轻的患者、具有重叠或未特指病变的患者以及在 2012-2016 年期间诊断的患者，晚期 GCA 的可能性更高。按位置分层，在晚期疾病方面，非西班牙裔白人和拉丁裔之间没有差异。按解剖部位分层，贲门 GCA 的拉丁裔患者比非西班牙裔白人更有可能患有晚期 GCA（OR：1.13，p=0.008）。在县级层面，TX 中社会剥夺程度中等和较高的县与 STX 相比，晚期 GCA 的几率更高（OR：1.25 和 1.20，p=0.007 和 0.028），而 NOS GCA 患者的社会剥夺指数（SDI）中等（OR：1.21，p=0.01）。
STX 拉丁裔人群的 GCA 差异大于 TX 和美国的 GCA 差异。年龄较小和社会剥夺程度增加了晚期 GCA 的风险，而拉丁裔和女性则特别容易发生晚期贲门 GCA。需要针对特定人群、文化响应的干预和预防措施，并开展更多研究以阐明促成风险因素。
