Background:Gastric cancer (GC) remains a significant health burden in the U.S, particularly among ethnic minorities. We identified patient-level risk factors contributing to advanced-stage (AS) diagnosis and poor survival to guide strategies to address GC-related health disparities.Methods:We conducted a retrospective cohort analysis of 18,396 histologically confirmed GC cases (4102 early-stage (ES) and 14,294 AS) diagnosed between 2000 and 2019, using data from the California Cancer Registry linked to the California Office of Statewide Health Planning and Development. Eligible cases were adults age ≥ 18 with complete diagnostic and follow-up data. Multivariable logistic and Cox regression models were used to identify predictors of AS-GC and five-year disease-specific (DSS) and overall-survival (OS) outcomes. Analyses were further stratified by Asian and Hispanic subgroups.Results:Korean heritage was the strongest predictor of ES-GC [OR 0.58 (95% CI, 0.47–0.71),p< 0.001] and was independently associated with the lowest GC-specific mortality risk [HR 0.73 (95% CI: 0.67–0.80),p< 0.0001]. The youngest age group (18–44 years) had the highest AS-GC rate (91.4%). Asian ethnicity, receipt of care at NCI-designated cancer centers, and prior upper endoscopy were associated with improved OS and DSS. In contrast, comorbidities such as GERD, diabetes, liver disease, smoking and alcohol abuse, and older age ≥ 75, U.S.-birth, and rural residence were linked to worse outcomes.Conclusions:Distinct demographic, clinical, and healthcare access factors contribute to disparities in GC outcomes. These findings support the development of culturally tailored early-detection programs, and risk-based screening for GC care, particularly in vulnerable populations.
背景：胃癌在美国，尤其是在少数族裔中，仍然是一个重大的健康负担。我们识别了导致晚期诊断和不良生存的患者层面风险因素，以指导解决胃癌相关健康差异的策略。 方法：我们利用加州癌症登记处与加州全州健康规划与发展办公室关联的数据，对2000年至2019年间诊断的18,396例经组织学确诊的胃癌病例（其中4,102例为早期，14,294例为晚期）进行了回顾性队列分析。符合条件的病例为年龄≥18岁且具有完整诊断和随访数据的成年人。采用多变量逻辑回归和Cox回归模型来确定晚期胃癌的预测因素，以及五年疾病特异性生存和总生存结局。分析进一步按亚裔和西班牙裔亚组进行分层。 结果：韩国裔是早期胃癌最强的预测因素[比值比 0.58 (95% 置信区间, 0.47–0.71), p < 0.001]，并且独立地与最低的胃癌特异性死亡风险相关[风险比 0.73 (95% 置信区间: 0.67–0.80), p < 0.0001]。最年轻的年龄组（18-44岁）晚期胃癌率最高（91.4%）。亚裔种族、在美国国家癌症研究所指定的癌症中心接受治疗以及既往接受过上消化道内镜检查与改善的总生存和疾病特异性生存相关。相比之下，胃食管反流病、糖尿病、肝病、吸烟和酗酒等合并症，以及年龄≥75岁、美国出生和农村居住地与较差的结局相关。 结论：不同的人口统计学、临床和医疗可及性因素导致了胃癌结局的差异。这些发现支持制定针对特定文化的早期检测计划，以及基于风险的胃癌护理筛查，特别是在脆弱人群中。
Health Inequity of Stage and Survival of Gastric Cancer in California
肿瘤(癌症)患者之家