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Wang X, Zhang S, Zhao Y, Meng S, Wang J, Wu Z, Ni J. Individual and joint associations of socioeconomic inequalities and unhealthy lifestyle with incident gastric cancer: A prospective cohort study. Public Health 2025; 243:105730. [PMID: 40286771 DOI: 10.1016/j.puhe.2025.105730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 03/29/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVES Gastric cancer (GC) remains a significant public health challenge, with accumulating evidence indicating an association between socioeconomic status (SES) and GC risk. This study aimed to examine the independent and synergistic effects of SES and lifestyle on GC incidence within a large prospective cohort. STUDY DESIGN Prospective cohort study. METHODS Data were analysed from 349,908 UK Biobank participants using latent class analysis to determine SES (household income, education, employment). Lifestyle was assessed based on smoking status, alcohol consumption, physical activity, body mass index and diet. Multivariable Cox regression tested associations between SES, lifestyle and GC, with mediation and interaction analyses used to explore their relationships. RESULTS SES was significantly associated with GC risk (hazard ratio [HR] = 1.35, 95 % confidence interval [CI], 1.20-1.52). An unhealthy lifestyle was also linked to increased GC risk (HR = 1.48, 95 % CI, 1.30-1.68). Individuals with low SES and an unhealthy lifestyle had a 195 % higher risk of GC compared to those with high SES and a healthy lifestyle (HR = 2.95, 95 % CI, 2.11-4.11). Mediation analysis indicated that 5.26 % of the SES-GC risk association was mediated by lifestyle factors. No significant interaction between SES and lifestyle was observed. CONCLUSIONS Low SES was related to an increased risk of GC, some of which may be mediated by unhealthy lifestyle. Public health initiatives should focus on addressing socioeconomic disparities and improving lifestyle factors to reduce GC incidence.
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Affiliation(s)
- Xiang Wang
- Department of Epidemiology and Biostatistics, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China; Chaohu Hospital of Anhui Medical University, Hefei, China; Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Shangxin Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuqiang Zhao
- Department of Epidemiology and Biostatistics, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China; Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Shiyin Meng
- Department of Epidemiology and Biostatistics, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China; Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Epidemiology and Biostatistics, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China; Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Zhuoyi Wu
- Department of Epidemiology and Biostatistics, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China; Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Jing Ni
- Department of Epidemiology and Biostatistics, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China; Chaohu Hospital of Anhui Medical University, Hefei, China.
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Yasinzai AQK, Saeed A. Age-Related Differences in Gastric Adenocarcinoma from 2000-2020: A SEER Database Analysis. J Gastrointest Cancer 2025; 56:78. [PMID: 40080286 DOI: 10.1007/s12029-025-01168-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2025] [Indexed: 03/15/2025]
Abstract
INTRODUCTION Gastric cancer (GC) is the 5th most common malignancy worldwide. Adenocarcinoma accounts for 95% of all GC. While most cases of gastric adenocarcinoma (GAC) arise in older age males, a significant proportion of biological disparity exists between different ages. In this study, we aim to compare the demographics and prognostic outcomes of different ages of patients with GAC. METHODS This retrospective study utilized the GAC cases abstracted from the Surveillance, Epidemiology, and End Results Program's 17 registries dataset from 2000 to 2020. Cases were divided into different age group brackets to comparatively explore characteristics of GAC. RESULTS A total of 103,674 cases were identified. The median age was 69 years, with a significant proportion 39.7% (n = 41,154) falling within the 66-80 age bracket cases. Female proportions were higher in the ≤ 35 years age group 47.2% (n = 960) and ≥ 81 years age group 45.7% (n = 9,695). About 45.1% (n = 916) of ≤ 35 years age group cases were Hispanic, while 60% (n = 12,715) of ≥ 81 years age group cases were non-Hispanic White. Ages between 51-65 and 66-80 years had higher proportions of liver metastasis 17% and 16% than their younger and older peers. Age ≤ 35 years cases are more likely to present at cardia 20.5%. Male gender had the worst survival across all age groups, with the worst in the ≤ 35 age group hazard ratio (H.R) 1.22(1.007 - 1.250 p < 0.001). Black had the worst survival across all ages, with the worst in the ≤ 35 years age group H.R 1.405 (1.164 - 1.696 p < 0.001). When plotted against other races in each age group, Hispanics had poor survival at young ages H.R 1.224 (1.069 - 1.401) and superior survival at older ages, with H.R 0.944 (0.902 - 0.987) in the ≥ 81 age group. Tumors located in the greater curvature and overlapping lesions demonstrated worse prognosis compared to cardia. Conversely, tumors in the pylorus and lesser curvature generally exhibited better prognosis. CONCLUSION In the United States GAC predominantly affects older adults, but early-onset cases exhibit aggressive histologies and poor survival, particularly more common in Hispanics. Black individuals face the worst survival outcomes across all age groups. Gender inclination towards males shrinks at the extremes of ages. At different age brackets, the demographics and prognosis changes, necessitating customized interventions.
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Affiliation(s)
- Abdul Qahar Khan Yasinzai
- Department of Medicine, Division of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, 15232, USA
| | - Anwaar Saeed
- Department of Medicine, Division of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA.
- UPMC Hillman Cancer Center, Pittsburgh, PA, 15232, USA.
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Aminpour N, Phan V, Wang H, McDermott J, Valentin M, Mishra A, DeLia D, Noel M, Al-Refaie W. Clinician-to-clinician connectedness and access to gastric cancer surgery at National Cancer Institute-designated cancer centers. J Gastrointest Surg 2024; 28:1526-1532. [PMID: 38910084 DOI: 10.1016/j.gassur.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND For patients with gastric cancer, the pathway from primary care (PC) clinician to gastroenterologist to cancer specialist (medical oncologist or surgeons) is referral dependent. The impact of clinician connectedness on disparities in quality gastric cancer care, such as at National Cancer Institute-designated cancer centers (NCI-CC), remains underexplored. This study evaluated how clinician connectedness influences access to gastrectomy at NCI-CC. METHODS Maryland's All-Payer Claims Database was used to evaluate 667 patients who underwent gastrectomy for cancer from 2013 to 2018. Two separate referral linkages, defined as ≥9 shared patients, were examined: (1) PC clinicians to gastroenterologists at NCI-CC and (2) gastroenterologists to cancer specialists at NCI-CC. Multiple logistic regression models determined associations between referral linkages and odds of undergoing gastrectomy at NCI-CC. RESULTS Only 15% of gastrectomies were performed at NCI-CC. Patients of gastroenterologists with referral links to cancer specialists at NCI-CC were more likely to be <65 years, male, White, and privately insured. Every additional referral link between PC clinician and gastroenterologist at NCI-CC and between gastroenterologist and cancer specialist at NCI-CC increased the odds of gastrectomy at NCI-CC by 71% and 26%, respectively. Black patients had half the odds as White patients in receiving gastrectomy at NCI-CC; however, adjusting for covariates including clinician-to-clinician connectedness attenuated this observation. CONCLUSION Patients of clinicians with low connectedness and Black patients are less likely to receive gastrectomy at NCI-CC. Enhancing clinician connectedness is necessary to address disparities in cancer care. These results are relevant to policy makers, clinicians, and patient advocates striving for health equity.
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Affiliation(s)
- Nathan Aminpour
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States
| | - Vy Phan
- Georgetown University School of Medicine, Washington, DC, United States
| | - Haijun Wang
- MedStar Health Research Institute, Hyattsville, MD, United States
| | - James McDermott
- Department of Surgery, Stanford University, Stanford, CA, United States
| | - Michelle Valentin
- Georgetown University School of Medicine, Washington, DC, United States
| | - Ankit Mishra
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Derek DeLia
- Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, United States
| | - Marcus Noel
- Department of Medicine, MedStar-Georgetown University Hospital, Washington, DC, United States
| | - Waddah Al-Refaie
- Department of Surgery, Creighton University School of Medicine and CHI Health, Omaha, NE, United States.
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Zhou S, Liang Z, Li Q, Tian W, Song S, Wang Z, Huang J, Ren M, Liu G, Xu M, Zheng ZJ. Individual and area-level socioeconomic status, Life's Simple 7, and comorbid cardiovascular disease and cancer: a prospective analysis of the UK Biobank cohort. Public Health 2024; 234:178-186. [PMID: 39024928 DOI: 10.1016/j.puhe.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES We aimed to investigate the associations of individual and area-level socioeconomic status (SES) with incident cardiovascular diseases (CVD) alone, cancer alone, and comorbid CVD and cancer, and the mediation role of cardiovascular health score in these associations. STUDY DESIGN This was a population-based prospective cohort study. METHODS We used data from the UK Biobank, a population-based prospective cohort study. Latent class analysis was used to create an individual-level SES index based on three indicators (household income, education level, and employment status), and the Townsend Index was defined as the area-level socioeconomic status. We used the American Heart Association's (AHA) Life's Simple 7 (smoking, body weight, physical activity, diet, blood pressure, blood glucose, and total cholesterol) to calculate the cardiovascular health score. We used Cox proportional hazard regression models to estimate the hazard ratio (HR) and 95% confidence interval (CI) adjusted for demographic, environmental, and genetic factors. RESULTS Compared with high SES, the HRs in participants with low individual and area-level SES were 1.33 (95% confidence interval [CI] 1.29 to 1.38) and 1.24 (95% CI 1.20 to 1.29) for incident CVD, 0.96 (95% CI 0.93 to 0.99) and 0.95 (95%CI 0.92 to 0.98) for incident cancer, 1.32 (95%CI 1.24 to 1.40) and 1.15 (95%CI 1.08 to 1.22) for incident comorbid CVD and cancer, respectively. Additionally, the mediation proportion of CVD score for individual and area-level SES was 47.93% and 48.87% for incident CVD, 44.83% and 59.93% for incident comorbid CVD and cancer. The interactions between individual-level SES and CVD scores were significant on incident CVD, and comorbid CVD and cancer, and the protective associations were stronger in participants with high individual-level SES. CONCLUSIONS Life's Simple 7 significantly mediated the associations between SES and comorbid CVD and cancer, while almost half of the associations remained unclear.
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Affiliation(s)
- S Zhou
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Z Liang
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Q Li
- Institute of Social Development, Chinese Academy of Macroeconomic Research, Beijing, China
| | - W Tian
- Department of Global Statistics, Eli Lilly and Company, Branchburg, New Jersey, USA
| | - S Song
- Department of Health Policy & Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Z Wang
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - J Huang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - M Ren
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China
| | - G Liu
- Institute for Global Health and Development, Peking University, Beijing, China
| | - M Xu
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
| | - Z-J Zheng
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
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Park J, Jung W, Han K, Kim B, Lee SY, Yoon JM, Lim DH, Shin DW. Association between age-related macular degeneration and risk of incident cancer. Br J Ophthalmol 2024; 108:1249-1256. [PMID: 38418207 DOI: 10.1136/bjo-2023-323874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/08/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIMS Age-related macular degeneration (AMD) and cancer may share similar risk factors, indicating possible common pathogenic pathways. We aimed to describe the site-specific cancer risk based on the relationship of AMD with visual disability (VD) status. METHODS This was a population-based cohort study using data from the Korean National Health Insurance Service database (2009-2019) including patients who participated in a national health screening programme in 2009. The subjects were categorised based on the presence of AMD and VD. The occurrence of cancer was identified using principal diagnosis according to the International Classification of Disease, 10th revision codes in claims data. The Cox regression hazard model was used to compare HRs of site-specific cancer. RESULTS Among 4 088 814 participants, 51 596 had AMD of which 3683 subjects had VD. The mean follow-up period was 9.6 years. The overall cancer risk was generally null, but the risk of hypervascular cancer such as thyroid cancer (adjusted HR (aHR) 1.10, 95% CI 1.00 to 1.20) and renal cancer (aHR 1.16, 95% CI 1.00 to 1.33) was higher and the risk of stomach cancer (aHR 0.89, 95% CI 0.84 to 0.94) was lower in the AMD group than in the non-AMD group. CONCLUSION This study demonstrated a possible association between AMD and several cancers. Increased renal and thyroid cancer risk among patients with AMD could indicate that AMD is associated with hypervascular cancer. Further studies in which additional databases are used and the underlying detailed mechanisms evaluated are needed to validate our results.
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Affiliation(s)
- Junhee Park
- Family Medicine, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Wonyoung Jung
- Family Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea (the Republic of)
| | - Kyungdo Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Korea (the Republic of)
| | - Bongseong Kim
- Statistics and Actuarial Science, Soongsil University, Seoul, Korea (the Republic of)
| | - Seung-Yeon Lee
- Family medicine/ International Health care center, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Je Moon Yoon
- Ophthalmology, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Dong Hui Lim
- Ophthalmology, Samsung Medical Center, Seoul, Korea (the Republic of)
- Clinical Research Design & Evaluation and Digital Health, Samsung Advanced Insitute for Health Sicences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Dong Wook Shin
- Family Medicine, Samsung Medical Center, Seoul, Korea (the Republic of)
- Clinical Research Design & Evaluation and Digital Health, Samsung Advanced Insitute for Health Sicences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea (the Republic of)
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Fei-Zhang DJ, Schellenberg SJ, Bentrem DJ, Wayne JD, Pawlik TM. The associations of food environment with gastrointestinal cancer outcomes in the United States. J Surg Oncol 2024; 129:1490-1500. [PMID: 38648421 DOI: 10.1002/jso.27656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Social conditions and dietary behaviors have been implicated in the rising burden of gastrointestinal cancers (GIC). The "food environment" reflects influences on a community level relative to food availability, nutritional assistance, and social determinants of health. Using the US Department of Agriculture-Food Environment Atlas (FEA), we sought to characterize the association of food environment on GIC presenting stage and long-term survival. METHODS Patients diagnosed with GIC between 2013 and 2017 were identified using the SEER database. FEA-scores were based on 282 county-level food security variables, store-restaurant availability, SNAP/WIC enrollment, pricing/taxes, and producer vicinity adjusted-for factors of socioeconomic status, race-ethnicity, transportation access, and comorbidities. Relative FEA rankings across US counties were averaged into a composite score and assigned to patients by county-of-residence. The association of FEA, cancer stage, and survival were analyzed using multiple logistic regression and cox-proportional hazard models relative to White/non-White race/ethnicity. RESULTS Among 287,148 patients, the most common GIC-sites were colon (n = 97,942, 34%), pancreas (n = 49,785, 17.3%), liver (n = 31,098, 11.0%) and esophagus (n = 16,271, 5.7%). A worse food environment was independently associated with increased odds of late-stage diagnosis (esophageal odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.01-1.05; hepatic OR: 1.06, 95% CI: 1.03-1.08; pancreatic OR: 1.04, 95% CI: 1.01-1.06) among all patients; in contrast, food environment was associated with colorectal cancer stage among non-White patients only (OR: 1.04, 95% CI: 1.03-1.06). Worse food environment was associated with worse 3-year survival (colon OR: 1.03, 95% CI: 1.01-1.04; hepatic OR: 1.12, 95% CI: 1.08-1.17; gastric OR: 1.07, 95% CI: 1.01-1.13). Similar associations were noted relative to overall survival among the entire cohort (biliary tract hazard ratio [HR]: 1.03, 95% CI: 1.01-1.05; esophageal HR: 1.02, 95% CI: 1.01-1.04; hepatic HR: 1.07, 95% CI: 1.06-1.09; pancreatic HR: 1.04, 95% CI: 1.02-1.05; rectum HR: 1.03, 95% CI: 1.01-1.04; gastric HR: 1.05, 95% CI: 1.03-1.07), as well as among non-White patients (biliary HR: 1.04, 95% CI: 1.01-1.07; colon HR: 1.03, 95% CI: 1.01-1.05; esophageal HR: 1.05, 95% CI: 1.02-1.08; hepatic HR: 1.08, 95% CI: 1.06-1.10) (all p < 0.003). CONCLUSIONS Food environment was independently associated with late-stage tumor presentation and worse 3-year and overall survival among GIC patients. Interventions to address inequities across communities relative to food environments are needed to alleviate disparities in cancer care.
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Affiliation(s)
- David J Fei-Zhang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - David J Bentrem
- Department of Surgery, Division of Surgical Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey D Wayne
- Department of Surgery, Division of Surgical Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Melkonian SC, Jim MA, Reza A, Peipins LA, Haverkamp D, Said N, Sharpe JD. Incidence of Stomach, Liver, and Colorectal Cancers by Geography and Social Vulnerability Among American Indian and Alaska Native Populations, 2010-2019. Am J Epidemiol 2024; 193:58-74. [PMID: 37823258 PMCID: PMC10990004 DOI: 10.1093/aje/kwad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/12/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Abstract
Social determinants of health and associated systems, policies, and practices are important drivers of health disparities. American Indian and Alaska Native (AI/AN) populations in the United States have elevated incidence rates of stomach, liver, and colorectal cancers compared with other racial/ethnic groups. In this study, we examined incidence rates of 3 types of gastrointestinal cancer among non-Hispanic AI/AN (NH-AI/AN) and non-Hispanic White (NHW) populations by geographic region and Social Vulnerability Index (SVI) score. Incident cases diagnosed during 2010-2019 were identified from population-based cancer registries linked with the Indian Health Service patient registration databases. Age-adjusted incidence rates (per 100,000 population) for stomach, liver, and colorectal cancers were compared within NH-AI/AN populations and between the NH-AI/AN and NHW populations by SVI score. Rates were higher among NH-AI/AN populations in moderate- and high-SVI-score counties in Alaska, the Southern Plains, and the East than in low-SVI counties. Incidence rates among NH-AI/AN populations were elevated when compared with NHW populations by SVI category. Results indicated that higher social vulnerability may drive elevated cancer incidence among NH-AI/AN populations. Additionally, disparities between NH-AI/AN and NHW populations persist even when accounting for SVI. Exploring social vulnerability can aid in designing more effective interventions to address root causes of cancer disparities among AI/AN populations.
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Affiliation(s)
- Stephanie C. Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Melissa A. Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Avid Reza
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Lucy A. Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Nathania Said
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - J. Danielle Sharpe
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
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Sarkeala T, Lamminmäki M, Nygård M, Njor SH, Virtanen A, Leivonen A, Hirvonen E, Toikkanen S, Campbell S, Stefansdóttir H, Ursin G, Heinävaara S. Cervical, liver and stomach cancer incidence and mortality in non-Western immigrant women: a retrospective cohort study from four Nordic countries. Acta Oncol 2023; 62:977-987. [PMID: 37594889 DOI: 10.1080/0284186x.2023.2245557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Cervical, liver and stomach cancers are the most common infection-associated malignancies and the leading cause of morbidity in non-Western regions. We compared the incidence and mortality of these cancers between non-Western immigrant and non-immigrant Nordic female populations. We also analysed the effect of age at immigration, duration of residence and education on cancer burden. MATERIAL AND METHODS Study population consisted of women residents in Denmark, Finland, Iceland and Norway in 1973-2020. Non-Western women contributed 3.1% of the total 260 million person-years at risk. All women were followed from their 20th birthday, or from the date of immigration if after, until the date of their first primary cancer diagnosis, death, emigration, or the end of the country-specific study period. All data were adjusted for 10-year age groups and calendar periods, and immigrant data was further broken down by region of birth, age at immigration and education level. Country-specific estimates were produced by multivariable Poisson regression and pooled in Finland with a random effects model. RESULTS Altogether, there were 60 982 cases of cervical, liver and stomach cancer in the study population, causing 36 582 deaths. The immigrant women had significantly higher liver (rate ratio [RR] 1.78, 95% confidence interval (CI) 1.03-3.06) and stomach cancer incidence (RR 1.68, CI 1.29-2.18), and stomach cancer mortality (RR 1.49, CI 1.17-1.92) than non-immigrant women. In the immigrant population, high education was related to lower incidence and mortality of studied cancers. The rate ratio of cervical cancer decreased with duration of residence and increased with rising age at immigration. CONCLUSION Due to the increased incidence and mortality of infection-related cancers and changes in cancer patterns by age at immigration and duration of residence, attention should be paid to targeted health care services for immigrants. Special efforts should be given to women who have spent their youth in high-risk areas.
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Affiliation(s)
| | | | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Sisse Helle Njor
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anni Virtanen
- Finnish Cancer Registry, Helsinki, Finland
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Aku Leivonen
- Finnish Cancer Registry, Helsinki, Finland
- Data and Analytics Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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9
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Kwon MJ, Kang HS, Kim MJ, Kim NY, Choi HG, Lim H. Chronic Periodontitis and the Potential Likelihood of Gastric Cancer: A Nested Case-Control Study in the Korean Population Utilizing a National Health Sample Cohort. Cancers (Basel) 2023; 15:3974. [PMID: 37568790 PMCID: PMC10417201 DOI: 10.3390/cancers15153974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
There is limited information regarding the potential association between chronic periodontitis (CP) and gastric cancer, especially in the Korean population. This study aimed to explore this relationship. This nested case-control study analyzed data from 10,174 patients with gastric cancer and 40,696 controls from the Korean National Health Insurance Service-National Sample Cohort using propensity score matching. Standardized differences were used to compare baseline characteristics between study groups. Logistic regression analyses adjusted for confounders were conducted to assess the association between history of CP and gastric cancer occurrence. CP histories and comprehensive subgroup analyses in the 1- and 2-year periods preceding the index date were evaluated. Individuals with a history of CP within the 1-year and 2-year periods showed an increased likelihood of developing gastric cancer. Subgroup analyses consistently supported these findings in male participants aged <65 years and individuals with various income levels or living in residential areas. However, no significant associations were observed among participants aged ≥65 years. In conclusion, CP may be a potential risk factor for gastric cancer development in the Korean population. Regular screening for gastric cancer may be necessary for high-risk individuals, specifically men aged <65 years with a history of CP.
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Affiliation(s)
- Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea;
| | - Hyo Geun Choi
- Suseo Seoul E.N.T. Clinic and MD Analytics, Seoul 06349, Republic of Korea;
| | - Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
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10
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Villarroel-Espindola F, Ejsmentewicz T, Gonzalez-Stegmaier R, Jorquera RA, Salinas E. Intersections between innate immune response and gastric cancer development. World J Gastroenterol 2023; 29:2222-2240. [PMID: 37124883 PMCID: PMC10134417 DOI: 10.3748/wjg.v29.i15.2222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
Worldwide, gastric cancer (GC) is the fifth most commonly diagnosed malignancy. It has a reduced prevalence but has maintained its poor prognosis being the fourth leading cause of deaths related to cancer. The highest mortality rates occur in Asian and Latin American countries, where cases are usually diagnosed at advanced stages. Overall, GC is viewed as the consequence of a multifactorial process, involving the virulence of the Helicobacter pylori (H. pylori) strains, as well as some environmental factors, dietary habits, and host intrinsic factors. The tumor microenvironment in GC appears to be chronically inflamed which promotes tumor progression and reduces the therapeutic opportunities. It has been suggested that inflammation assessment needs to be measured qualitatively and quantitatively, considering cell-infiltration types, availability of receptors to detect damage and pathogens, and presence or absence of aggressive H. pylori strains. Gastrointestinal epithelial cells express several Toll-like receptors and determine the first defensive line against pathogens, and have been also described as mediators of tumorigenesis. However, other molecules, such as cytokines related to inflammation and innate immunity, including immune checkpoint molecules, interferon-gamma pathway and NETosis have been associated with an increased risk of GC. Therefore, this review will explore innate immune activation in the context of premalignant lesions of the gastric epithelium and established gastric tumors.
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Affiliation(s)
- Franz Villarroel-Espindola
- Translational Medicine Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago 7500000, Metropolitan region, Chile
| | - Troy Ejsmentewicz
- Translational Medicine Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago 7500000, Metropolitan region, Chile
| | - Roxana Gonzalez-Stegmaier
- Translational Medicine Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago 7500000, Metropolitan region, Chile
| | - Roddy A Jorquera
- Translational Medicine Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago 7500000, Metropolitan region, Chile
| | - Esteban Salinas
- Translational Medicine Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago 7500000, Metropolitan region, Chile
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11
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He S, Sun D, Li H, Cao M, Yu X, Lei L, Peng J, Li J, Li N, Chen W. Real-World Practice of Gastric Cancer Prevention and Screening Calls for Practical Prediction Models. Clin Transl Gastroenterol 2023; 14:e00546. [PMID: 36413795 PMCID: PMC9944379 DOI: 10.14309/ctg.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Some gastric cancer prediction models have been published. Still, the value of these models for application in real-world practice remains unclear. We aim to summarize and appraise modeling studies for gastric cancer risk prediction and identify potential barriers to real-world use. METHODS This systematic review included studies that developed or validated gastric cancer prediction models in the general population. RESULTS A total of 4,223 studies were screened. We included 18 development studies for diagnostic models, 10 for prognostic models, and 1 external validation study. Diagnostic models commonly included biomarkers, such as Helicobacter pylori infection indicator, pepsinogen, hormone, and microRNA. Age, sex, smoking, body mass index, and family history of gastric cancer were frequently used in prognostic models. Most of the models were not validated. Only 25% of models evaluated the calibration. All studies had a high risk of bias, but over half had acceptable applicability. Besides, most studies failed to clearly report the application scenarios of prediction models. DISCUSSION Most gastric cancer prediction models showed common shortcomings in methods, validation, and reports. Model developers should further minimize the risk of bias, improve models' applicability, and report targeting application scenarios to promote real-world use.
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Affiliation(s)
- Siyi He
- 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/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Dianqin Sun
- 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/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - He Li
- 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/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Maomao Cao
- 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/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Xinyang Yu
- 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/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Lin Lei
- Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province, China
| | - Ji Peng
- Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province, China
| | - Jiang Li
- 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/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Ni Li
- 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/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Wanqing Chen
- 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/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
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12
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Kattan J, Karak FE, Farhat F, Gerges DA, Mokaddem W, Chahine G, Khairallah S, Fakhruddin N, Makarem J, Nasr F. Prevalence of Her2-neu status and its clinicopathological association in newly diagnosed gastric cancer patients. BMC Cancer 2022; 22:1114. [PMID: 36316658 PMCID: PMC9623963 DOI: 10.1186/s12885-022-10206-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background This study aimed to report the prevalence of HER2-neu in newly diagnosed early or metastatic gastric cancer (GC) patients, to determine the percentage of patients achieving various IHC scores correlating with the ISH results and to establish a database for GC patients in Lebanon. Methods This was a national, multicenter, descriptive and cross-sectional study in patients with histologically confirmed early or metastatic GC newly diagnosed. All eligible patients underwent the IHC and ISH tests in a central laboratory. Demographics, medical history and histopathology data were collected. Results One hundred fifty-seven patients were included (mean age at diagnosis: 63 ± 14.1 years) during a 3.5 year period. The prevalence of HER2-neu over expression was 21% (95% CI: 15.3–27.4) using ICH and ISH. Agreement between IHC and ISH results was significantly substantial (kappa = 0.681; p-value < 0.001). Over expressed HER2-neu status was significantly associated with high ECOG performance status only. Conclusions The prevalence of HER2-neu over expression in newly diagnosed early or metastatic GC patients seemed to be high in Lebanon. The database generated allows to monitor trends in the epidemiology and management of GC.
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Affiliation(s)
- Joseph Kattan
- grid.413559.f0000 0004 0571 2680Hôtel-Dieu de France University Hospital, Beirut, Lebanon ,grid.42271.320000 0001 2149 479XSaint-Joseph University, Beirut, Lebanon
| | - Fady el Karak
- grid.413559.f0000 0004 0571 2680Hôtel-Dieu de France University Hospital, Beirut, Lebanon ,grid.42271.320000 0001 2149 479XSaint-Joseph University, Beirut, Lebanon
| | - Fadi Farhat
- grid.42271.320000 0001 2149 479XSaint-Joseph University, Beirut, Lebanon ,grid.477313.50000 0004 0622 8161Department of Hematology and Oncology, Hammoud Hospital University Medical Center, Saida, Lebanon
| | - Dany Abi Gerges
- Department of Hematology and Oncology, Middle East Institute of Health, Bsalim, Lebanon
| | - Walid Mokaddem
- Department of Hematology and Oncology, Haykal Hospital, Tripoli, Lebanon
| | - Georges Chahine
- grid.413559.f0000 0004 0571 2680Hôtel-Dieu de France University Hospital, Beirut, Lebanon ,grid.42271.320000 0001 2149 479XSaint-Joseph University, Beirut, Lebanon
| | | | - Najla Fakhruddin
- grid.477313.50000 0004 0622 8161Department of Pathology, Hammoud Hospital, Saida, Lebanon
| | - Jawad Makarem
- Department of Hematology and Oncology, Ain W Zain Hospital, Ain W Zain, Lebanon
| | - Fadi Nasr
- Department of Hematology and Oncology, Mount Lebanon Hospital, Beirut, Lebanon
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13
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Gonzalez‐Pons M, Torres‐Cintrón CR, Soto‐Salgado M, Vargas‐Ramos Y, Perez‐Portocarrero L, Morgan DR, Cruz‐Correa M. Racial/ethnic disparities in gastric cancer: A 15-year population-based analysis. Cancer Med 2022; 12:1860-1868. [PMID: 35785449 PMCID: PMC9883558 DOI: 10.1002/cam4.4997] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/15/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND AIMS Disparities in gastric cancer incidence and mortality have been reported among ethnic/racial groups. While gastric cancer is not common in the U.S., it is among the top 10 causes of cancer-related death among Hispanics living in Puerto Rico (PRH). This study compared gastric cancer incidence rates during a 15-year period (2002-2006, 2007-2011, and 2012-2016) between PRH and racial/ethnic groups in the mainland U.S., including Non-Hispanic Whites (NHW), Non-Hispanics Blacks (NHB), Hispanics (USH), and Non-Hispanic Asian or Pacific Islanders (NHAPI). METHODS Primary gastric cancer cases (ICD-O-3 codes C16.0 to C16.9) from the Puerto Rico Central Cancer Registry and SEER diagnosed from January 1, 2002 to December 31, 2016 were included in the analysis. The Joinpoint Regression Program and standardized rate ratios were used to estimate Annual Percent Changes (APC) and differences in gastric cancer incidence among racial/ethnic groups, respectively. RESULTS Our analysis included 83,369 gastric cancer cases (PRH n = 4202; NHW n = 43,164; NHB n = 10,414; NHAPI n = 11,548; USH n = 14,041). USH had the highest number of cases among individuals <50 years, whereas NHW and PRH had the highest percentage among individuals ≥50 years. PRH and USH were the only groups with increasing APCs among individuals <50 years. CONCLUSIONS Gastric cancer continues to be a common cancer among PRH, despite the overall decrease in incidence among other racial/ethnic groups. Studies evaluating the gastric cancer risk factors among high-risk groups are necessary to establish health policy and modify gastric cancer screening algorithms among Hispanics.
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Affiliation(s)
- Maria Gonzalez‐Pons
- Division of Cancer BiologyUniversity of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA
| | - Carlos R. Torres‐Cintrón
- Analysis and Epidemiology Unit Coordinator / Biostatistician, Puerto Rico Central Cancer Registry, Division of Cancer Control and Population SciencesUniversity of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA
| | - Marievelisse Soto‐Salgado
- Division of Cancer Control and Population SciencesUniversity of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA
| | - Yimari Vargas‐Ramos
- Division of Cancer BiologyUniversity of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA
| | | | - Douglas R. Morgan
- Director of Division of Gastroenterology and HepatologyUniversity of Alabama, BirminghamBirminghamAlabamaUSA
| | - Marcia Cruz‐Correa
- University of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA,Department of Medicine and BiochemistryUniversity of Puerto Medical Sciences CampusSan JuanPuerto RicoUSA
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14
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Xu J, Du S, Dong X. Associations of Education Level With Survival Outcomes and Treatment Receipt in Patients With Gastric Adenocarcinoma. Front Public Health 2022; 10:868416. [PMID: 35757623 PMCID: PMC9218109 DOI: 10.3389/fpubh.2022.868416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background It remains largely unclear how education level, an important socioeconomic factor, affects prognoses for patients with gastric adenocarcinoma (GAC). We aimed to demonstrate the associations between education level and clinical outcomes in patients with GAC. Methods We included a total of 30,409 patients diagnosed with GAC from the Surveillance, Epidemiology, and End Results 18 registry database. Education level, household income, unemployment rate, poverty rate, insurance status, and marital status were selected as sociodemographic variables for the comprehensive analysis. Cox and logistic regression models, Kaplan–Meier curves, and subgroup analyses were the primary statistical methods employed. Results A low level of education was correlated with less income, higher unemployment rates, and higher poverty rates (all p < 0.001). The multivariate Cox analysis indicated that a high education level was significantly associated with superior overall survival rates and cancer-specific survival rates in patients with GAC (both p < 0.001). We also corroborated favorable survival outcomes by high education level within almost every clinical and demographic subgroup. Furthermore, chemotherapy combined with surgery could markedly prolong the survival for all patients, including patients of stage IV cancer (both p < 0.001). By using multivariable logistic models, patients in counties with high education levels had a higher probability of chemotherapy receipt (p < 0.001). Contrarily, those in the counties with low levels of education were less likely to receive chemotherapy or undergo surgery (p < 0.001). Conclusions Education level was identified and confirmed as an independent predictor of treatment and survival for GAC patients. Efforts are needed to provide effective interventions for those whose educational status is adverse.
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Affiliation(s)
- Jiaxuan Xu
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Education, Nanjing University, Nanjing, China
| | - Shuhui Du
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Education, Nanjing University, Nanjing, China
| | - Xiaoqing Dong
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Education, Nanjing University, Nanjing, China
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15
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Sun D, Lei L, Xia C, Li H, Cao M, He S, Zhang Z, Guo G, Song G, Peng J, Chen W. Sociodemographic disparities in gastric cancer and the gastric precancerous cascade: A population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 23:100437. [PMID: 35355616 PMCID: PMC8958536 DOI: 10.1016/j.lanwpc.2022.100437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND 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). METHODS 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. RESULTS 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. INTERPRETATION 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. FUNDING Sanming Project of Medicine in Shenzhen, National Natural Science Foundation, and Special Project of Bejing-Tianjin-Hebei Basic Research Cooperation.
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Affiliation(s)
- Dianqin Sun
- 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
| | - Lin Lei
- Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Changfa Xia
- 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
| | - He Li
- 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
| | - Maomao Cao
- 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
| | - Siyi He
- 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
| | - Zhiyi Zhang
- Department of Gastroenterology, Gansu Wuwei Tumor Hospital, Wuwei, China
| | - Guizhou Guo
- Linzhou Cancer Hospital, Anyang 456500, China
| | - Guohui Song
- Cixian Cancer Institute, Handan 056500, China
| | - Ji Peng
- Department of Gastroenterology, Gansu Wuwei Tumor Hospital, Wuwei, China
| | - Wanqing Chen
- 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
- Corresponding author.
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16
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Cattelan L, Ghazawi FM, Le M, Lagacé F, Rahme E, Zubarev A, Sasseville D, Litvinov IV, Waschke KA, Netchiporouk E. Geographic and Socioeconomic Disparity of Gastric Cancer Patients in Canada. ACTA ACUST UNITED AC 2021; 28:2052-2064. [PMID: 34071354 PMCID: PMC8161777 DOI: 10.3390/curroncol28030190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
Gastric cancer is the 5th most common malignancy worldwide, representing ~5–10% of all new cancer cases. Although its incidence is declining, it is estimated that 1 in 98 Canadians will develop gastric cancer in their lifetime. The epidemiology and distribution of gastric cancer throughout Canada, however, remains poorly understood. A retrospective analysis of demographic data across Canada between 1992 and 2010 was performed using 2 population-based cancer registries. The incidence of gastric cancer was examined at the levels of provinces, cities, and postal codes. In addition, 43,955 patients were diagnosed with gastric cancer in Canada between 1992 and 2010; 66% were male and the average age of diagnosis was 68.4 years. The age-adjusted incidence rate was 5.07 cases per 100,000 individuals per year. The incidence decreased over the study period by 30%. High incidence rates were identified in rural areas of Newfoundland and Labrador, New Brunswick, and Quebec. Our study found a significant association between gastric cancer incidence rates and lower socioeconomic status, as well as Hispanic ethnicity. This is the first study to provide a comprehensive analysis of the incidence of gastric carcinoma in Canada, identifying high-risk populations that may benefit from increased primary and secondary prevention.
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Affiliation(s)
- Leila Cattelan
- Division of Dermatology, McGill University, Montreal, QC H4A 3J1, Canada; (L.C.); (M.L.); (F.L.); (A.Z.); (D.S.); (I.V.L.)
| | - Feras M. Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Michelle Le
- Division of Dermatology, McGill University, Montreal, QC H4A 3J1, Canada; (L.C.); (M.L.); (F.L.); (A.Z.); (D.S.); (I.V.L.)
| | - François Lagacé
- Division of Dermatology, McGill University, Montreal, QC H4A 3J1, Canada; (L.C.); (M.L.); (F.L.); (A.Z.); (D.S.); (I.V.L.)
| | - Elham Rahme
- Division of Clinical Epidemiology, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Andrei Zubarev
- Division of Dermatology, McGill University, Montreal, QC H4A 3J1, Canada; (L.C.); (M.L.); (F.L.); (A.Z.); (D.S.); (I.V.L.)
| | - Denis Sasseville
- Division of Dermatology, McGill University, Montreal, QC H4A 3J1, Canada; (L.C.); (M.L.); (F.L.); (A.Z.); (D.S.); (I.V.L.)
| | - Ivan V. Litvinov
- Division of Dermatology, McGill University, Montreal, QC H4A 3J1, Canada; (L.C.); (M.L.); (F.L.); (A.Z.); (D.S.); (I.V.L.)
| | - Kevin A. Waschke
- Division of Gastroenterology, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Elena Netchiporouk
- Division of Dermatology, McGill University, Montreal, QC H4A 3J1, Canada; (L.C.); (M.L.); (F.L.); (A.Z.); (D.S.); (I.V.L.)
- Correspondence:
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