河南省居民胃癌发病影响因素病例对照研究

Determinants of gastric cancer incidence among residents of Henan province:a case-control study

目的了解河南省居民胃癌患病的影响因素,为当地制定胃癌防治策略提供参考依据。方法通过河南省肿瘤登记报告系统在淮河流域4个县(区)抽取2020年1月—2021年7月确诊的198例新发胃癌患者作为病例组,并根据性别、年龄进行1:2匹配选取与病例组胃癌患者同乡镇或临近乡镇居住的396名健康居民作为对照组,采用条件logistic回归模型分析胃癌患病的影响因素。结果病例组胃癌患者吸烟、二手烟暴露、饮水量<1000 mL/d、经常发脾气、近10年情绪变化较差或压力越来越大、口味偏咸、盐阈值检测为4、偏好烫食、偏好硬食、喜食辣食、偶尔或经常吃剩饭、食用或处理后食用霉变食物、食用盐渍食品>1次/周、体质指数偏瘦和有胃部疾病史的比例分别为57.6%、69.2%、52.0%、17.2%、27.8%、47.0%、34.8%、36.9%、19.2%、51.5%、70.7%、8.1%、21.2%、11.6%和54.0%,均高于对照组健康居民的49.7%、60.6%、33.1%、4.5%、9.3%、28.5%、24.5%、27.5%、8.8%、40.7%、49.7%、2.5%、11.9%、1.8%和29.0%,病例组胃癌患者饮酒、饮茶、日常锻炼≥3天/周、饭后散步≥3天/周、安装家用净水器、规律就餐、每天吃早餐和食用生蒜或蒜苗≥10 g/d的比例分别为11.1%、16.2%、15.2%、34.3%、26.8%、78.8%、86.9%和25.3%,均低于对照组健康居民的36.1%、25.0%、23.7%、48.5%、41.9%、89.4%、92.7%和33.8%,差异均有统计学意义(均P<0.05);多因素条件logistic回归分析结果显示,二手烟暴露、经常发脾气、近10年情绪变化较差或压力越来越大、口味偏咸、偏好硬食、偶尔或经常吃剩饭、体质指数偏瘦、有胃部疾病史和有胃癌家族史为河南省居民胃癌发病的危险因素,初中及以上文化程度、家庭人均年收入≥5000元、安装家用净水器、体质指数超重和肥胖为河南省居民胃癌发病的保护因素。结论健康生活方式、性格情绪特征、饮食习惯、胃部疾病史和胃癌家族史均为河南省居民胃癌发病的主要影响因素。

Objective To understand the influencing factors of gastric cancer incidence among residents in Henan province,providing a reference for the formulation of local gastric cancer prevention and control strategies.Methods Through the Henan Provincial Cancer Registration and Reporting System,198 gastric cancer patients(141 males and 57 females with a median age of 66 years)newly diagnosed between January 2020 and July 2021 in four counties in the Huaihe River basin were selected as the case group.A 1:2 sex and age matching was performed to select 396 healthy residents from the same or adjacent counties as the control group.A face-to-face interview with a standardized questionnaire developed by a group of domestic researchers,physical examination,salt taste threshold test,and detection of Helicobacter pylori infection were conducted among the participants.Conditional logistic regression models were used to analyze the factors influencing gastric cancer morbidity.Results Compared to controls,cases had significantly higher proportions of smoking(57.6%vs.49.7%),exposure to secondhand smoke(69.2%vs.60.6%),daily water intake<1000 ml(52.0%vs.33.1%),frequent anger(17.2%vs.4.5%),poor mood or increased stress in the last 10 years(27.8%vs.9.3%),preference for salty food(47.0%vs.28.5%),with a salt taste threshold of 4(34.8%vs.24.5%),preference for hot food(36.9%vs.27.5%),preference for hard food(19.2%vs.8.8%),preference for spicy food(51.5%vs.40.7%),occasionally or frequently eating leftovers(70.7%vs.49.7%),eating or handling moldy food(8.1%vs.2.5%),eating pickled food more than once a week(21.2%vs.11.9%),being underweight(11.6%vs.1.8%),and having a history of gastric disease(54.0%vs.29.0%)(all P<0.05),whereas cases had significantly lower proportions of drinking alcohol(11.1%vs.36.1%),drinking tea(16.2%vs.25.0%),being physically active three or more days a week(15.2%vs.23.7%),walking after meals three or more days per week(34.3%vs.48.5%),using a water filter at home(26.8%vs.41.9%),eating regular meals(78.8%vs.89.4%),eating breakfast every day(86.9%vs.92.7%),and consuming 10 or more grams of raw garlic or garlic sprouts per day(25.3%vs.33.8%)(all P<0.05).Multivariate conditional logistic regression analysis revealed the following risk factors for gastric cancer incidence among residents:exposure to secondhand smoke,frequent anger,poor mood or increased stress in the past 10 years,preference for salty food,preference for hard food,occasional or frequent consumption of leftovers,being underweight,having a history of gastric disease,and family history of gastric cancer;the analysis also revealed the following protective factors against gastric cancer incidence:having an education of junior high school or above,having an annual household income of≥5000 Chinese yuan per capita,using a water filter at home,and being overweight or obese.Conclusion Lifestyle,personality and emotional characteristics,dietary habits,history of gastric diseases,and family history of gastric cancer are the main influencing factors of gastric cancer morbidity among residents in Henan province.