Racial and Ethnic Differences in Gastric Cancer by Stage of Diagnosis in the United States (2009-2019)

Despite the United States having a low overall gastric cancer incidence rate, there remain disparities by race/ethnicity. We examined the incidence of gastric cancer by stage at diagnosis among Hispanic, Asian/Pacific Islander (A/PI), American Indian/Alaska Native (AI/AN), and non-Hispanic Black (NHB) populations, compared with the non-Hispanic White (NHW) population, during 2009 to 2019.

Using Surveillance, Epidemiology, and End Results data, age-adjusted gastric cancer incidence rates, rate ratios (RR), and 95% confidence intervals (CI) were calculated by stage and race/ethnicity. Stratified analyses were performed by sex, age, and anatomic site.

Compared with NHW individuals, the incidence rates of regional and distant-stage gastric cancer diagnoses were nearly two times higher in Hispanic (RRregional, 1.87; 95% CI, 1.78-1.97; RRdistant, 1.92; 95% CI, 1.84-2), A/PI (RRregional, 2.17; 95% CI, 2.04-2.30; RRdistant, 1.58; 95% CI, 1.49-1.68), and NHB (RRregional, 1.78; 95% CI, 1.67-1.88; RRdistant, 1.80; 95% CI, 1.71-1.89) individuals. In stratified analyses, the increased rate of advanced-stage diagnosis for Hispanic, A/PI, and NHB individuals remained generally consistent by sex and age, although young AI/AN individuals also had a significantly higher rate of distant gastric cancer (RR, 2.38; 95% CI, 1.36-3.83). By site, the increased rates of advanced-stage diagnosis were limited to noncardia and overlapping/unspecified gastric cancer, whereas these populations had lower rates of cardia gastric cancer than NHW individuals.

Hispanic, A/PI, and NHB individuals have disproportionately high advanced-stage noncardia gastric cancer rates compared with NHW individuals.

This study has identified significant disparities in advanced-stage noncardia gastric cancer, suggesting the need to identify strategies to improve early detection in these populations.