Race/Ethnicity and Birthplace as Risk Factors for Gastric Intestinal Metaplasia in a Multiethnic United States Population

Authors

Mimi C Tan
Taher Jamali
Theresa H Nguyen
Amy Galvan
Robert J Sealock
Anam Khan
Neda Zarrin-Khameh
Ashley Holloman
Ourania Kampagianni
David Henriquez Ticas
Yan Liu
Hashem B El-Serag
Aaron P Thrift

Publication Date

2-1-2022

Journal

The American Journal of Gastroenterology

DOI

10.14309/ajg.0000000000001576

PMID

34908535

PMCID

PMC8816815

PubMedCentral® Posted Date

2-1-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Adult, Biopsy, Birth Setting, Cross-Sectional Studies, Ethnicity, Humans, Incidence, Metaplasia, Middle Aged, Population Surveillance, Precancerous Conditions, Racial Groups, Retrospective Studies, Risk Factors, Stomach, Stomach Neoplasms, Texas, gastric intestinal metaplasia, gastric cancer, race/ethnicity, birthplace, risk factors, epidemiology

Abstract

INTRODUCTION: Several US subgroups have increased risk of gastric cancer and gastric intestinal metaplasia (GIM) and may benefit from targeted screening. We evaluated demographic and clinical risk factors for GIM and examined the interaction between race/ethnicity and birthplace on GIM risk.

METHODS: We identified patients who had undergone esophagogastroduodenoscopy with gastric biopsy from 3/2006-11/2016 using the pathology database at a safety net hospital in Houston, Texas. Cases had GIM on ≥1 gastric biopsy histopathology, whereas controls lacked GIM on any biopsy. We estimated odds ratios and 95% confidence intervals (CI) for associations with GIM risk using logistic regression and developed a risk prediction model of GIM risk. We additionally examined for associations using a composite variable combining race/ethnicity and birthplace.

RESULTS: Among 267 cases with GIM and 1,842 controls, older age (vs(adjORs) 2.02; 95% CI 1.17-3.29; >60 years adjOR 4.58; 95% CI 2.61-8.03), Black race (vs non-Hispanic White: adjOR 2.17; 95% CI 1.31-3.62), Asian race (adjOR 2.83; 95% CI 1.27-6.29), and current smoking status (adjOR 2.04; 95% CI 1.39-3.00) were independently associated with increased GIM risk. Although non-US-born Hispanics had higher risk of GIM (vs non-Hispanic White: adjOR 2.10; 95% CI 1.28-3.45), we found no elevated risk for US-born Hispanics (adjOR 1.13; 95% CI 0.57-2.23). The risk prediction model had area under the receiver operating characteristic of 0.673 (95% CI 0.636-0.710) for discriminating GIM.

DISCUSSION: We found that Hispanics born outside the United States were at increased risk of GIM, whereas Hispanics born in the United States were not, independent of Helicobacter pylori infection. Birthplace may be more informative than race/ethnicity when determining GIM risk among US populations.

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