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Racial/ethnic differences in survival among gastric cancer patients in california

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Abstract

Background

Gastric cancer is an important cause of death among racial/ethnic minorities in the U.S. The objective of this study was to investigate racial disparities in survival among gastric cancer patients within demographic and disease subgroups.

Methods

Patients diagnosed with invasive epithelial gastric cancer between 2006 and 2015 were identified from the California Cancer Registry. Cox proportional hazards regression was used to identify factors associated with survival among non-Hispanic whites (NHWs, n = 7,475), non-Hispanic blacks (NHBs, n = 1,246), Hispanics (n = 6,274), and Asians/Pacific Islanders (APIs, n = 4,204). Survival was compared across race/ethnicity within subgroups of demographic and disease factors. Five-year relative survival was also calculated within subgroups.

Results

There were notable differences in patient characteristics by race/ethnicity, but predictors of survival were similar for each group. Overall, APIs (HR = 0.83, 95% CI: 0.79, 0.88, p < 0.0001) and Hispanics (HR = 0.94, 95% CI: 0.90, 0.99, p = 0.0104) had better survival than NHWs, but NHBs and NHWs did not have different prognosis (HR = 1.06, 95% CI: 0.98, 1.15, p = 0.2237). The survival advantage of APIs persisted in nearly every demographic and disease subgroup, but Hispanics and NHBs had similar survival as NHWs in most groups. Race was not a significant predictor of survival among those with public or no insurance and patients with cardia tumors.

Conclusions

There are some differences in survival by race/ethnicity, but race/ethnicity alone cannot explain disparate outcomes in gastric cancer. Future studies, particularly ones that investigate the role of population-specific etiological factors and molecular tumor profiles, are needed to further understand factors associated with survival.

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Acknowledgments

The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute, Cancer Registry of Greater California. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. LGC-C receives funding from COLCIENCIAS (grant 110565843382 - 204-2015), University of Tolima (projects 160114 and 160120516), University of California Davis (School of Medicine Dean’s Fellowship in Precision Health Equity; Office of the Provost funding for the Latino Cancer Health Equity Initiative), the National Institute of Environmental Health Sciences (Pilot grant from P30ES023513) and the National Cancer Institute (grants R01CA223978, R21CA199631, U54CA233306 and P30CA093373).

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Author notes

  1. Luis G. Carvajal-Carmona and Rosemary D. Cress are co-senior authors.

Authors and Affiliations

  1. Public Health Institute, Cancer Registry of Greater California, 1825 Bell St, Ste 102, Sacramento, CA, USA

    Amy K. Klapheke & Rosemary D. Cress

  2. Department of Public Health Sciences, University of California Davis, Davis, CA, USA

    Amy K. Klapheke & Rosemary D. Cress

  3. Population Sciences and Health Disparities Program, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA

    Luis G. Carvajal-Carmona & Rosemary D. Cress

  4. Genome Center and Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA

    Luis G. Carvajal-Carmona

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  1. Amy K. Klapheke
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  3. Rosemary D. Cress
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Correspondence to Amy K. Klapheke.

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Klapheke, A.K., Carvajal-Carmona, L.G. & Cress, R.D. Racial/ethnic differences in survival among gastric cancer patients in california. Cancer Causes Control 30, 687–696 (2019). https://doi.org/10.1007/s10552-019-01184-0

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