Abstract

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.This was a retrospective cohort study, with endpoint of GAC incidence as ascertained through linkage to an institutional tumor registry. We utilized 2010-2020 data from the Palo Alto Medical Foundation, a large multispecialty practice serving Northern California. The analytic cohort comprised individuals aged 40-75 receiving regular ambulatory care. Variables collected included demographic, medical, pharmaceutical, social, and familial data. Electronic phenotyping was based on rules-based methods.The cohort comprised 316,044 individuals and ~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% 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 non-steroidal anti-inflammatory drug 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.Routine EHR data can stratify the general population for GAC risk.Such methods may help triage populations for targeted screening efforts, such as upper endoscopy.

View details for DOI 10.1158/1055-9965.EPI-23-1200

View details for PubMedID 38231023