Gut 63:64-71 doi:10.1136/gutjnl-2013-305033
  • Stomach
  • Original article

The burden of stomach cancer in indigenous populations: a systematic review and global assessment

  1. Freddie Bray2
  1. 1Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
  2. 2Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
  3. 3Division of Health and Culture, Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
  4. 4Centre for Public Health Research, Massey University, Wellington, New Zealand
  1. Correspondence to Dr Melina Arnold, Section for Cancer Information, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69008, France; ArnoldM{at}
  • Received 5 April 2013
  • Revised 1 October 2013
  • Accepted 2 October 2013
  • Published Online First 23 October 2013


Objective Stomach cancer is a leading cause of cancer death, especially in developing countries. Incidence has been associated with poverty and is also reported to disproportionately affect indigenous peoples, many of whom live in poor socioeconomic circumstances and experience lower standards of health. In this comprehensive assessment, we explore the burden of stomach cancer among indigenous peoples globally.

Design The literature was searched systematically for studies on stomach cancer incidence, mortality and survival in indigenous populations, including Indigenous Australians, Maori in New Zealand, indigenous peoples from the circumpolar region, native Americans and Alaska natives in the USA, and the Mapuche peoples in Chile. Data from the New Zealand Health Information Service and the Surveillance Epidemiology and End Results (SEER) Program were used to estimate trends in incidence.

Results Elevated rates of stomach cancer incidence and mortality were found in almost all indigenous peoples relative to corresponding non-indigenous populations in the same regions or countries. This was particularly evident among Inuit residing in the circumpolar region (standardised incidence ratios (SIR) males: 3.9, females: 3.6) and in Maori (SIR males: 2.2, females: 3.2). Increasing trends in incidence were found for some groups.

Conclusions We found a higher burden of stomach cancer in indigenous populations globally, and rising incidence in some indigenous groups, in stark contrast to the decreasing global trends. This is of major public health concern requiring close surveillance and further research of potential risk factors. Given evidence that improving nutrition and housing sanitation, and Helicobacter pylori eradication programmes could reduce stomach cancer rates, policies which address these initiatives could reduce inequalities in stomach cancer burden for indigenous peoples.