Sun Dianqin, Lei Lin, Xia Changfa, Li He, Cao Maomao, He Siyi, Zhang Zhiyi, Guo Guizhou, Song Guohui, Peng Ji, Chen Wanqing
Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing 100021, China.
Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China.
Lancet Reg Health West Pac. 2022 Mar 25;23:100437. doi: 10.1016/j.lanwpc.2022.100437. eCollection 2022 Jun.
Gastric carcinogenesis is a multistep process initiating with chronic gastritis and progressing through atrophy, intestinal metaplasia, and dysplasia to carcinoma. This study aims to comprehensively investigate sociodemographic disparities in each stage of gastric carcinogenesis and estimate to what extent the inequalities could be ascribed to risk factors of gastric cancer (GC).
We used the baseline data from a community-based study in China's high-risk areas, totalling 27094 participants. Gastric mucosa status was ascertained by endoscopy and biopsies. An overall socioeconomic status (SES) variable was generated by latent class analysis. We calculated relative risks (RRs) and 95% confidence intervals (CIs) using modified Poisson regression to assess associations of sociodemographic factors with each cascade stage. We estimated the percentage of the excess risk for neoplastic lesions among vulnerable populations that can be explained by established risk factors.
Age and sex showed associations with all gastric lesions, whose RRs increased with lesion progressing. Compared with individuals without schooling, the RRs of neoplastic lesions for people with primary, secondary, and post-secondary education were 0·86 (95% CI 0·76-0·97), 1·00 (95% CI 0·88-1·13), and 0·70 (95% CI 0·47-1·03), respectively. Participants with medium SES had a lower risk of neoplastic lesions than people in the low SES group (RR 0·83, 95% CI 0·74-0·93). GC risk factors could explain 33·6% of the excess risk of neoplastic lesions among men and a small proportion of the disparities among SES groups.
Age and sex were essential sociodemographic factors for GC and precursor diseases. Individuals with low educational levels or SES were more likely to have neoplastic lesions. About one-third of the sex difference and a slight fraction of the socioeconomic inequalities could be attributed to included risk factors.
Sanming Project of Medicine in Shenzhen, National Natural Science Foundation, and Special Project of Bejing-Tianjin-Hebei Basic Research Cooperation.
胃癌发生是一个多步骤过程，始于慢性胃炎，经萎缩、肠化生和发育异常发展为癌症。本研究旨在全面调查胃癌发生各阶段的社会人口学差异，并估计这些不平等在多大程度上可归因于胃癌（GC）的危险因素。
我们使用了中国高危地区一项基于社区研究的基线数据，共27094名参与者。通过内镜检查和活检确定胃黏膜状态。通过潜在类别分析生成总体社会经济地位（SES）变量。我们使用修正的泊松回归计算相对风险（RRs）和95%置信区间（CIs），以评估社会人口学因素与每个级联阶段的关联。我们估计了既定危险因素可解释的脆弱人群中肿瘤性病变额外风险的百分比。
年龄和性别与所有胃部病变均有关联，其RRs随病变进展而增加。与未受过教育的个体相比，小学、中学和大专学历人群的肿瘤性病变RRs分别为0·86（95%CI 0·76 - 0·97）、1·00（95%CI 0·88 - 1·13）和0·70（95%CI 0·47 - 1·03）。中等SES参与者的肿瘤性病变风险低于低SES组人群（RR 0·83，95%CI 0·74 - 0·93）。GC危险因素可解释男性中33·6%的肿瘤性病变额外风险以及SES组间差异的一小部分。
年龄和性别是GC及其前驱疾病的重要社会人口学因素。教育水平低或SES低的个体更易发生肿瘤性病变。约三分之一的性别差异和一小部分社会经济不平等可归因于纳入的危险因素。
深圳医学“三名工程”、国家自然科学基金、京津冀基础研究合作专项。
