Department of Population Health Sciences, Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Department of Medicine and Psychiatry and Behavioral Sciences, Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Cancer Med. 2024 Mar;13(6):e7002. doi: 10.1002/cam4.7002.
Latinos/Hispanics are at higher risk for developing gastric cancer (GC) compared with non-Hispanic whites, and social determinants of health (SDoH) are thought to contribute.
AIMS/MATERIALS AND METHODS: This study addressed SDoH and their interactions contributing to disparities in the testing and treatment of Helicobacter pylori (HP) infection and diagnosis of GC and its known precursors, among Latinos/Hispanics relative to non-Latinos at two affiliated but independent health systems in San Antonio, Texas, using a mixed methods approach.
Secondary data abstraction and analysis showed that GCs represented 2.6% (n = 600) of our population. Men and older individuals were at higher GC risk. Individuals with military insurance were 2.7 times as likely to be diagnosed as private insurance. Latinos/Hispanics had significantly (24%) higher GC risk than Whites. Poverty and lack of insurance contributed to GC risk among the minorities classified as other (Asians, Native Americans, Multiracial; all p < 0.01). All SDoH were associated with H. pylori infection (p < 0.001). Qualitative analysis of patient and provider interviews showed providers reporting insurance as a major care barrier; patients reported appointment delays, and lack of clinic staff. Providers universally agreed treatment of H. pylori was necessary, but disagreed on its prevalence. Patients did not report discussing H. pylori or its cancer risk with providers.
DISCUSSION/CONCLUSION: These data indicate the importance of considering SDoH in diagnosis and treatment of GC and its precursors, and educating providers and patients on H. pylori risks for GC.
与非西班牙裔白人相比，拉丁裔/西班牙裔人群患胃癌（GC）的风险更高，人们认为健康的社会决定因素（SDoH）对此有影响。
目的/材料和方法：本研究采用混合方法，在德克萨斯州圣安东尼奥的两个附属但独立的健康系统中，针对 SDoH 及其相互作用进行了研究，这些因素导致拉丁裔/西班牙裔人群相对于非拉丁裔人群在检测和治疗幽门螺杆菌（HP）感染、诊断 GC 及其已知前体方面存在差异。
二次数据提取和分析表明，GC 占我们人群的 2.6%（n=600）。男性和年龄较大的个体患 GC 的风险更高。有军事保险的个体被诊断为私人保险的可能性是有私人保险的个体的 2.7 倍。与白人相比，拉丁裔/西班牙裔人群患 GC 的风险明显更高（高 24%）。贫困和缺乏保险是少数族裔（亚洲人、美洲原住民、多种族；均 p<0.01）患 GC 的风险因素。所有 SDoH 都与 HP 感染有关（p<0.001）。对患者和提供者访谈的定性分析表明，提供者报告保险是主要的护理障碍；患者报告预约延迟和诊所工作人员不足。提供者普遍认为治疗 HP 是必要的，但对其流行程度存在分歧。患者没有报告与提供者讨论 HP 或其患癌症的风险。
讨论/结论：这些数据表明，在诊断和治疗 GC 及其前体时，考虑 SDoH 非常重要，并应教育提供者和患者了解 HP 感染与 GC 的相关性。
