title: Age, poverty, acculturation, and gastric cancer.
abstract: BACKGROUND
  Gastric cancer is an aggressive disease, and overall changes in incidence rates have been noted. There are conflicting data on whether young patients have worse outcomes than older patients; the roles of tumor biology and access to care are critical to answering this question. Our objectives were to explore how gastric cancer rates, receipt of care, and outcomes are affected by age, poverty, and acculturation.
  
  
  METHODS
  A total of 42,187 patients were identified from the 1980-2009 Surveillance, Epidemiology, and End Results registry. We compared trends in incidence rates between patients <40, 40-64, and ≥65 years using ordinary least-squares regression. Separate multivariate regression models were used to evaluate the impact of age, poverty, and acculturation on receipt of cancer-directed therapy and hazard of mortality.
  
  
  RESULTS
  Patients <40 years had stable incidence rates over the 3-decade period compared with decreases for patients 40-64 and ≥65 years. They are also more likely to present with aggressive, advanced disease (P < .0001 for both). On unadjusted and adjusted analyses, patients <40 years were more likely to receive cancer-directed therapies and have better survival than those ≥65 years. Residing in high poverty areas was associated with not receiving appropriate cancer-directed therapy; the adjusted hazard ratio of mortality for surgically resected patients was, however, not affected by poverty. Residing in high immigration areas was associated with a low hazard ratio (HR, 0.74; 95% confidence interval [CI], 0.7-0.79) of mortality. Foreign-born patients also had a low hazard ratio (HR, 0.87; 95% CI, 0.83-0.91) of mortality.
  
  
  CONCLUSIONS
  Although trends in incidence rates for patients <40 years remain unchanged and their disease is aggressive and advanced at presentation, they do not experience disparities in gastric cancer-directed therapies and survival after resection. For patients residing in impoverished areas or high immigration communities, operative resection and adjustment for appropriate aftercare is associated with comparable or better survival when compared with those living in low poverty or low immigration areas. Disparities remain in receipt of appropriate cancer-directed therapies, and future efforts should focus on decreasing structural variations in care and unconscious biases regarding patients from these vulnerable communities.
authors: Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA. davidknguyen1@mednet.ucla.edu
authors: David K
authors: DK
authors: Nguyen
authors: Melinda
authors: M
authors: Maggard-Gibbons
mesh_terms: D000069:Acculturation; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011203:Poverty; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy