Differential Rates of Early Gastric Cancer in the Urban and Rural Medical Centers of Hangzhou, China

The aim of this study was to compare gastric cancer (GC) and early GC (EGC) diagnosis rates between urban and rural and to investigate potential reasons for the increased GC morbidity in rural areas.

Patients who underwent endoscopy at rural and urban medical centers from 2019 to 2024 were included. We analyzed differences in patients' pre-endoscopic chief complaints and endoscopic diagnoses across the 2 areas.

Thirty-two thousand six hundred thirteen patients from rural medical centers and 70,195 patients from urban centers were included. Significant differences in endoscopic diagnoses were found between the groups, with the EGC diagnosis rate being significantly lower in rural areas than in urban (10.19% vs. 27.19%). Rural patients were more likely to undergo endoscopy for abdominal pain, reflux, abdominal fullness, and melena (relative risk [RR] = 1.340, 1.431, 1.106, and 1.231, respectively). Fewer rural patients underwent endoscopy because of laboratory abnormality, including Helicobacter pylori infection, elevated tumor markers, positive fecal occult blood tests, and anemia (RR = 0.591, 0.295, 0.251, and 0.400, respectively). In addition, rural patients were significantly less likely to undergo endoscopy owing to health screening or surveillance for chronic atrophic gastritis (RR = 0.362 and 0.527, respectively).

The diagnosis rate of EGC is significantly lower in rural than in urban. Rural patients are more likely to seek endoscopy because they are symptomatic and are less likely to undergo endoscopy for health screening, surveillance for chronic atrophic gastritis, or laboratory abnormality. Enhanced health education and awareness programs in rural areas are needed to encourage proactive endoscopic screening and surveillance.