Racial and Ethnic Minorities at Increased Risk for Gastric Cancer in a Regional US Population Study
Racial and Ethnic Minorities at Increased Risk for Gastric Cancer in a Regional US Population Study
复制标题
DOI：
10.1016/j.cgh.2016.11.033
复制
发表时间：
2017-04-01
影响因子：
12.6
通讯作者：
Wu, Bechien U.
中科院分区：
文献类型：
--
作者：
Dong, Elizabeth;Duan, Lewei;Wu, Bechien U.
背景和目的：在美国，关于胃癌危险因素的数据有限。我们的目的是基于种族/民族和其他确定的危险因素来描述胃癌的风险。方法：我们从2008年至2014年在南加州的一个综合医疗保健系统中进行了一项回顾性队列研究，按种族/民族评估胃癌的发病率。然后，我们进行了一项年龄和性别匹配的病例队列研究，以评估其他危险因素：幽门螺杆菌感染、吸烟、家族史、肥胖、语言和社会经济地位。按种族/民族对语言和社会经济地位进行亚组分析。结果：参考人群（非西班牙裔白人）的胃癌发病率为8.2例（95%可信区间[CI]， 7.7-8.7） / 10万人年。亚洲人、西班牙裔和非西班牙裔黑人的发病率值更高：每10万人年分别为12.7 （95% CI, 11.1-14.3）、12.7 （95% CI, 11.7-13.7）和11.8 （95% CI, 10.3-13.2）例（均P < 0.0001）。在logistic回归分析中，我们发现种族/民族是胃癌的独立危险因素；与非西班牙裔白人相比，非西班牙裔黑人的比值比（OR）为1.5 (95% CI, 1.22-1.72, P < 0.0001)，西班牙裔的OR为1.4 (95% CI, 1.22-1.57, P < 0.0001)，亚洲人的OR为1.5 （95% CI, 1.28-1.81, P < 0.0001）。其他独立危险因素包括幽门螺杆菌感染（OR, 4.6; 95% CI, 3.8-5.7）、吸烟史（OR, 1.4; 95% CI, 1.3-1.6）和胃癌家族史（OR, 3.4; 95% CI, 2.6-4.4）（均P < 0.0001）。非英语语言是亚洲人胃癌的重要危险因素（P = 0.05）。较高的年收入中位数与降低的风险相关（OR, 0.84; 95% CI, 0.75-0.95; P = 0.0004）。结论：在南加州的一项人口研究中，我们发现与非西班牙裔白人人群相比，少数种族/民族的胃癌风险增加了40%-50%。除了幽门螺杆菌感染外，吸烟、家族史和低社会经济地位也与风险增加有关。进一步确定高危人群的特征可以确定适合进行针对性筛查的人群。
BACKGROUND AND AIMS: Limited data are available on risk factors for gastric cancer in the United States. We aimed to characterize risk for gastric cancer based on race/ethnicity and additional established risk factors.METHODS: We conducted a retrospective cohort study from 2008 to 2014 from an integrated health care system in Southern California to assess incidence of gastric cancer by race/ethnicity. We then conducted an age-and sex-matched case-cohort study to evaluate additional risk factors: Helicobacter pylori infection, tobacco use, family history, obesity, language, and socioeconomic status. Subgroup analysis was performed for language and socioeconomic status by race/ethnicity.RESULTS: The incidence of gastric cancer in the reference (non-Hispanic white) population was 8.2 (95% confidence interval [CI], 7.7-8.7) cases per 100,000 person-years. Incidence values for Asians, Hispanics, and non-Hispanic black persons were higher: 12.7 (95% CI, 11.1-14.3), 12.7 (95% CI, 11.7-13.7), and 11.8 (95% CI, 10.3-13.2) cases per 100,000 person-years, respectively (all P < .0001). In logistic regression analysis, we found race/ethnicity to be an independent risk factor for gastric cancer; the odds ratio (OR) for non-Hispanic black persons was 1.5 (95% CI, 1.22-1.72; P < .0001), the OR for Hispanics was 1.4 (95% CI, 1.22-1.57; P < .0001), and the OR for Asians was 1.5 (95% CI, 1.28-1.81; P < .0001), compared with the non-Hispanic white population. Other independent risk factors included infection with H pylori (OR, 4.6; 95% CI, 3.8-5.7), smoking history (OR, 1.4; 95% CI, 1.3-1.6), and family history of gastric cancer (OR, 3.4; 95% CI, 2.6-4.4) (all P < .0001). Non-English language was a significant risk factor for gastric cancer in Asians (P = .05). Higher annual median income was associated with reduced risk (OR, 0.84; 95% CI, 0.75-0.95; P = .0004).CONCLUSIONS: In a population study in Southern California, we found racial/ethnic minorities to have a 40%-50% increase in risk of gastric cancer compared with the non-Hispanic white population. In addition to H pylori infection, smoking, family history, and low socioeconomic status were also associated with increased risk. Further characterization of high-risk groups may identify populations appropriate for targeted screening.