Facilitators of and barriers to gastric cancer and precursor diagnosis among South Texas residents: Social determinants of health

• Published in: Cancer medicine (Malden, MA) Vol. 13; no. 6; pp. e7002 - n/a
• Main Authors: Parma, Dorothy Long, Finley, Erin P., Fernandez, Roman, Gelfond, Jonathan A. L., Ramirez, Amelie G.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-03-2024; John Wiley and Sons Inc; Wiley
• Subjects: Bilingualism; Censuses; Codes; Confidentiality; Demographics; Diagnosis; Electronic health records; Gastric cancer; Gastroenterology; Health disparities; Helicobacter Infections - diagnosis; Helicobacter Infections - epidemiology; Helicobacter pylori; Hispanic Americans; Hispanic or Latino; Humans; Infections; Interviews; Latinos/Hispanics; Lymphoma; Male; Minority & ethnic groups; Mortality; Oncology; Patients; Preventive medicine; Primary care; Qualitative research; Social Determinants of Health; Socioeconomic factors; Socioeconomic status; Stomach Neoplasms - diagnosis; Stomach Neoplasms - epidemiology; Stomach Neoplasms - therapy; Texas - epidemiology; Ulcers; White; Women; Texas; United States > US; social determinants of health; Helicobacter pylori; gastric cancer; Latinos/Hispanics
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.7002

Background
Latinos/Hispanics are at higher risk for developing gastric cancer (GC) compared with non‐Hispanic whites, and social determinants of health (SDoH) are thought to contribute.
Aims/Materials and Methods
This study addressed SDoH and their interactions contributing to disparities in the testing and treatment of Helicobacter pylori (HP) infection and diagnosis of GC and its known precursors, among Latinos/Hispanics relative to non‐Latinos at two affiliated but independent health systems in San Antonio, Texas, using a mixed methods approach.
Results
Secondary data ion and analysis showed that GCs represented 2.6% (n = 600) of our population. Men and older individuals were at higher GC risk. Individuals with military insurance were 2.7 times as likely to be diagnosed as private insurance. Latinos/Hispanics had significantly (24%) higher GC risk than Whites. Poverty and lack of insurance contributed to GC risk among the minorities classified as other (Asians, Native Americans, Multiracial; all p < 0.01). All SDoH were associated with H. pylori infection (p < 0.001). Qualitative analysis of patient and provider interviews showed providers reporting insurance as a major care barrier; patients reported appointment delays, and lack of clinic staff. Providers universally agreed treatment of H. pylori was necessary, but disagreed on its prevalence. Patients did not report discussing H. pylori or its cancer risk with providers.
Discussion/Conclusion
These data indicate the importance of considering SDoH in diagnosis and treatment of GC and its precursors, and educating providers and patients on H. pylori risks for GC.