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Open AccessArticle

Socio-Demographic Disparities in Gastric Adenocarcinoma: A Population-Based Study

1
Department of Medicine, University at Buffalo School of Medicine, Buffalo, NY 14263, USA
2
Division of Hematology & Oncology, Roswell Park Comprehensive Cancer Center, University at Buffalo School of Medicine, Buffalo, NY 14263, USA
3
Department of Surgical Oncology, Mayo Clinic, Rochester, MN 55905, USA
4
Department of Medicine, University of Connecticut School of Medicine, Farmington, CT 06030, USA
5
Department of Medicine, University of Connecticut Health, Hartford, CT 06030, USA
6
Institute of Agricultural Sciences, University of Calcutta, West Bengal 700073, India
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(1), 157; https://doi.org/10.3390/cancers12010157
Received: 23 December 2019 / Revised: 6 January 2020 / Accepted: 7 January 2020 / Published: 9 January 2020
(This article belongs to the Special Issue Recent Advances in Gastric Cancer)
Background: Gastric cancer is one of the leading causes of cancer-related mortality worldwide, accounting for 8.2% of cancer-related deaths. The purpose of this study was to investigate the geographic and sociodemographic disparities in gastric adenocarcinoma patients. Methods: We conducted a retrospective study in gastric adenocarcinoma patients between 2004 and 2013. Data were obtained from the National Cancer Data Base (NCDB). Univariate and multivariable analyses were performed to evaluate overall survival (OS). Socio-demographic factors, including the location of residence [metro area (MA) or rural area (RA)], gender, race, insurance status, and marital status, were analyzed. Results: A total of 88,246 [RA, N = 12,365; MA, N = 75,881] patients were included. Univariate and multivariable analysis showed that RA had worse OS (univariate HR = 1.08, p < 0.01; multivariate HR = 1.04; p < 0.01) compared to MA. When comparing different racial backgrounds, Native American and African American populations had poorer OS when compared to the white population; however, Asian patients had a better OS (multivariable HR = 0.68, p < 0.01). From a quality of care standpoint, MA patients had fewer median days to surgery (28 vs. 33; p < 0.01) with fewer positive margins (6.3% vs. 6.9%; p < 0.01) when compared to RA patients. When comparing the extent of lymph node dissection, 19.6% of MA patients underwent an extensive dissection (more than or equal to 15 lymph nodes) in comparison to 18.7% patients in RA (p = 0.03). Discussion: This study identifies socio-demographic disparities in gastric adenocarcinoma. Future health policy initiatives should focus on equitable allocation of resources to improve the outcomes. View Full-Text
Keywords: gastric; disparities; rural; urban; incidence; outcomes; adenocarcinoma; stomach gastric; disparities; rural; urban; incidence; outcomes; adenocarcinoma; stomach
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Rana, N.; Gosain, R.; Lemini, R.; Wang, C.; Gabriel, E.; Mohammed, T.; Siromoni, B.; Mukherjee, S. Socio-Demographic Disparities in Gastric Adenocarcinoma: A Population-Based Study. Cancers 2020, 12, 157.

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