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Upper Gastrointestinal (lips to ileocecal valve, including esophagus and stomach)

E443: Impact of Immigration and Race-Ethnicity on Gastric Cancer Incidence: An analysis of Multi-Ethnic Cohort study

Introduction: GC incidence varies across race/ethnicity and geographical origins. In the US, race/ethnicity and immigration are known risk factors for GC development. The combined effect of these risk factors on GC incidence is understudied.

Methods: Multi-Ethnic Cohort (MEC) data was analyzed. This large prospective cohort study collected diet and lifestyle data from individuals from 5 races/ethnicities (White, Black, Japanese, Latino, Hawaiian) between 1993-2014. Participants were followed for the development of cancer. Immigration was examined as 0 generation when both self and parents were born outside the US (0 gen), 1st generation if self was born in US but parents were born outside of US (1st gen), and 2nd generation self and parents were born in the US (2nd gen).  Cox proportional hazard models were used to analyze the effect of immigration generation and race/ethnicity on the risk of GC incidence while adjusting for demographic, dietary and lifestyle variables. 

Results: The data included 1,303 cases of GC and 190,883 controls. Latino, Japanese, and Hawaiian individuals had 2.5 to nearly 8 times the risk of GC compared to 2nd gen White individuals [HR range: Latino 2.3-3.0, Japanese 3.1-5.4, Hawaiian 2.9-7.8]. Decreasing risk with subsequent immigration generation was most prominently observed for Japanese [HR: 0 gen 5.45 (95% CI 3.56-7.44); 1st gen 3.93 (95% CI 3.03-5.10); 2nd gen 3.1 (95% CI 2.24-4.27)], and Hawaiians [HR: 0 gen 7.77 (95% CI 107-56.00); 1st gen 4.63 (95% CI2.75-7.79); 2nd gen 2.90 (95% CI 2.06-4.05)]. No difference was observed by generation for Latino individuals and risk remained at approximately 3 times risk in all generations. Compared to 2nd gen Whites, 2nd gen Blacks had 2.41 times the risk of GC [HR: 2.41, 95% CI 1.82-3.20], while increased risk was not observed in 0 gen and 1st gen Black immigrants. Kaplan Meier curves showed probability of developing GC by age 80 to be significantly higher for 2nd generation Blacks (0.67%, p< 0.0001), all Latino generations (0.63-0.95%, p< 0.0001), all Japanese generations (0.79-1.25%, p< 0.0001), and 2nd and 1st generation Hawaiians (0.84-1.53%, p< 0.0001) when compared to the reference (2nd generation White 0.25%).  

Conclusions:

The effect of immigration on risk of GC is not uniform among race/ethnic groups. The interplay between race/ethnicity and immigration on GC risk needs to be considered when studying immigration-based risk models on GC incidence. Our results suggest complex etiologies in the natural history of GC due to race/ethnicity and a person’s geographical origin in the world.

Learning Objectives:

  • describe the compounding effect race and immigration have on gastric cancer incidence
  • identify targeted approaches to screening and surveillance based on patient race and immigration generation
  • hypothesize factors that contribute to increased gastric cancer incidence related to a patient's race and immigration generation