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

BACKGROUND: Despite the United States having a low overall gastric cancer (GC) incidence rate, there remain disparities by race/ethnicity. We examined the incidence of GC by stage at diagnosis among Hispanic, Asian/Pacific Islander (A/PI), American Indian/Alaska Native (AI/AN), and non-Hispanic Black (NHB) populations, compared to non-Hispanic White (NHW) population, during 2009-2019. METHODS: Using Surveillance, Epidemiology, and End Results data, age-adjusted GC incidence rates, rate ratios (RRs) and 95% confidence intervals (CIs) were calculated by stage and race/ethnicity. Stratified analyses were performed by sex, age and anatomical site. RESULTS: Compared to NHW individuals, incidence rates of regional and distant stage GC diagnosis were nearly two times higher in Hispanic (RRRegional, 1.87; 95% CI, 1.78-1.97; RRDistant, 1.92; 95% CI, 1.84-2.00), 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 GC (RR, 2.38; 95% CI, 1.36-3.83). By site, the increased rates of advanced-stage diagnosis were limited to non-cardia and overlapping/unspecified GC, whereas these populations had lower rates of cardia GC than NHW individuals. CONCLUSIONS: Hispanic, A/PI, and NHB individuals have disproportionately high advanced-stage non-cardia GC rates compared to NHW individuals. IMPACT: This study has identified significant disparities in advanced-stage non-cardia GC, suggesting the need to identify strategies to improve early detection in these populations.