Study Finds Key Risk Factors for Gastric Cancer in US Patients With Chronic Gastritis
Adults under age 65 diagnosed with chronic atrophic gastritis (CAG) face a measurable risk of progressing to non-cardia gastric cancer (NCGC), with certain clinical and demographic factors significantly increasing that risk, according to a new study published in PLOS One.
“In this population-based cohort study, we utilized the Commercial Claims and Encounters database to estimate the risk of transition from CAG to NCGC in a privately-insured population of individuals <65 years of age,” explained Robert Huang, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, United States of America, and coauthors. “We performed both cohort creation and outcome ascertainment using administrative coding, with a multi-step process to minimize misclassification.”
The research team identified 107 835 individuals with confirmed CAG and followed them for a total of 355 591 person-years. They found 348 incident cases of NCGC, corresponding to a crude incidence rate of 98 per 100 000 person-years. Risk was higher among men (HR 1.86), those aged 50 to 64 years old (HR 2.20), individuals with anemia (HR 5.09), smokers (HR 1.42), and those with a family history of digestive neoplasms (HR 1.45). Interestingly, prior Helicobacter pylori infection was inversely associated with cancer risk (HR 0.80), as was obesity (HR 0.77) and NSAID use (HR 0.62).
The researchers used rigorous inclusion criteria to confirm cases and outcomes using ICD codes and required multiple claims for diagnosis validation. Researchers also linked geographic socioeconomic data from the American Community Survey to capture neighborhood-level income. However, they found no consistent association between income and cancer risk in the multivariable model.
This research fills a gap in the understanding of CAG progression in US populations, particularly among individuals under 65 years old. While prior European registry data suggested a similar low absolute risk, this US-based cohort provides a more relevant reference for domestic screening and surveillance strategies.
“We believe the data from this study may serve as a valuable resource to define and estimate risk, and target higher-risk groups for prevention efforts,” concluded the study authors.
Reference
Huang RJ, Balasubramanian V, Shum MV, Ji HP, Hwang JH. Incidence of non-cardia gastric cancer among commercially-insured individuals aged 18-64 with chronic atrophic gastritis. PLoS One. 2025;20(6):e0315833. doi:10.1371/journal.pone.0315833
