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. 2024 Apr 3;33(4):547-556.
doi: 10.1158/1055-9965.EPI-23-1200.

Risk of Gastric Adenocarcinoma in a Multiethnic Population Undergoing Routine Care: An Electronic Health Records Cohort Study

Robert J Huang  1 , Edward S Huang  2 , Satish Mudiganti  3 , Tony Chen  3 , Meghan C Martinez  3 , Sanjay Ramrakhiani  2 , Summer S Han  4 , Joo Ha Hwang  1 , Latha P Palaniappan  5 , Su-Ying Liang  3
Affiliations

Risk of Gastric Adenocarcinoma in a Multiethnic Population Undergoing Routine Care: An Electronic Health Records Cohort Study

Robert J Huang et al. Cancer Epidemiol Biomarkers Prev. .

Abstract

Background: Gastric adenocarcinoma (GAC) is often diagnosed at advanced stages and portends a poor prognosis. We hypothesized that electronic health records (EHR) could be leveraged to identify individuals at highest risk for GAC from the population seeking routine care.

Methods: This was a retrospective cohort study, with endpoint of GAC incidence as ascertained through linkage to an institutional tumor registry. We utilized 2010 to 2020 data from the Palo Alto Medical Foundation, a large multispecialty practice serving Northern California. The analytic cohort comprised individuals ages 40-75 receiving regular ambulatory care. Variables collected included demographic, medical, pharmaceutical, social, and familial data. Electronic phenotyping was based on rule-based methods.

Results: The cohort comprised 316,044 individuals and approximately 2 million person-years (p-y) of observation. 157 incident GACs occurred (incidence 7.9 per 100,000 p-y), of which 102 were non-cardia GACs (incidence 5.1 per 100,000 p-y). In multivariable analysis, male sex [HR: 2.2, 95% confidence interval (CI): 1.6-3.1], older age, Asian race (HR: 2.5, 95% CI: 1.7-3.7), Hispanic ethnicity (HR: 1.9, 95% CI: 1.1-3.3), atrophic gastritis (HR: 4.6, 95% CI: 2.2-9.3), and anemia (HR: 1.9, 95% CI: 1.3-2.6) were associated with GAC risk; use of NSAID was inversely associated (HR: 0.3, 95% CI: 0.2-0.5). Older age, Asian race, Hispanic ethnicity, atrophic gastritis, and anemia were associated with non-cardia GAC.

Conclusions: Routine EHR data can stratify the general population for GAC risk.

Impact: Such methods may help triage populations for targeted screening efforts, such as upper endoscopy.

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Conflict of interest statement

Conflicts of Interest: The authors report no conflicts of interest, financial or otherwise, with regards to the submitted work.

Figures

Figure 1:
Figure 1:
Cumulative hazards plots of gastric adenocarcinoma (including cardia) in entire cohort (panel A), and stratified by age (panel B), sex (panel C), race/ethnicity (panel D), prior Helicobacter pylori diagnosis (panel E), and prior diagnosis of atrophic gastritis (panel F). Log-rank p-values presented in each panel. Corresponding persons at risk for each panel can be found in Supplemental Table S5.
Figure 2:
Figure 2:
Cumulative hazards plots of gastric adenocarcinoma (excluding cardia) in entire cohort (panel A), and stratified by age (panel B), sex (panel C), race/ethnicity (panel D), prior Helicobacter pylori diagnosis (panel E), and prior diagnosis of atrophic gastritis (panel F). Log-rank p-values presented in each panel. Corresponding persons at risk for each panel can be found in Supplemental Table S6.
See this image and copyright information in PMC

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