Higher Noncardia Gastric Cancer Risk Occurs Earlier in Hispanic and Asian Populations.

Background and Aims: Noncardia gastric cancer (GC) incidence in the United States varies substantially by race and ethnicity, but age-adjusted estimates do not indicate when higher-risk populations reach clinically meaningful levels of disease. We evaluated age-specific incidence across racial/ethnic and Asian ancestry groups to characterize differences in both the magnitude and timing of risk relative to non-Hispanic White (NHW) populations. Methods: We conducted a population-based analysis of noncardia GC incidence in California and New York from 2010 to 2022. Age-specific rates were estimated for NHW, Hispanic, and non-Hispanic Asian/Pacific Islander populations and for Asian subgroups (Chinese, Japanese, Korean, and Vietnamese). Rate ratios were calculated relative to NHW populations, and the age at which each group reached the incidence observed among NHW adults aged 60 to 69 years was identified. Results: Incidence increased with age and remained higher among Hispanic and Asian populations than among NHW populations. Substantial heterogeneity was observed across Asian ancestries, with rate ratios ranging from 2.83 to 5.98 at ages 40 to 49 and reaching 12.04 among Korean individuals at ages 60 to 69. Incidence levels observed among NHW adults aged 60 to 69 were reached up to 2 decades earlier in several Asian populations. Conclusion: Age-specific incidence of noncardia GC is higher among Hispanic and Asian populations than among NHW populations, with marked heterogeneity across Asian ancestries. These findings indicate a shift in the age distribution of risk, with clinically meaningful incidence occurring earlier in higher-risk populations. This age-specific pattern provides population-based evidence to inform risk assessment and consideration of earlier, risk-based prevention strategies.