Ethnic Inequity in the Current Approach to H. pylori Testing and Treatment: Linked Data Cohort Analysis

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2025-01-10 DOI:10.1111/hel.70005

Andrea Teng, Erin Hildred, James Stanley, Stephen Inns, Melissa McLeod

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Abstract

Background

As seen globally, there are up to sixfold differences in gastric cancer mortality by ethnicity in Aotearoa New Zealand, and H. pylori is the major modifiable risk factor. This study investigates whether current H. pylori testing and treatment approaches are equitable.

Materials and Methods

The study design was a retrospective cohort analysis of linked administrative health data. Laboratory testing data and pharmacy dispensing were linked to the Northern region health user population dataset (1.9 million) from 2015 to 2018. We investigated an individual's first test for H. pylori. Regression analyses compared ethnic differences in rates of H. pylori testing, infection, treatment, and retesting, adjusted for age, sex, and calendar year.

Results

Ethnic inequities were present across the clinical pathway. Compared to sole-European, testing rates were lowest in Māori (OR 0.69) and Pacific (OR 0.81) and highest in Middle-Eastern/Latin-American/African (MELAA) (OR 2.21) and Asian (OR 2.02). Positivity rates were highest in MELAA (RR 2.96, 39%) and Pacific (RR 2.84, 38%) followed by Asian (RR 1.93, 26%) and Māori (RR 1.71, 23%). Treatment rates were similar for Asian (HR 1.05), MELAA (HR 1.03), and Māori (HR 0.98) compared to sole-European but lower in Pacific (HR 0.90). Māori and Pacific were half as likely to be retested as sole-European.

Conclusions

Despite the higher prevalence of H. pylori and gastric cancer, Māori and Pacific are relatively underserved with lower rates of testing and treatment than sole-European. Improved guidelines and the consistent application of these along with an equity-focused test and treat program are likely to be particularly beneficial for Māori and Pacific in addressing inequities.

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当前幽门螺杆菌检测和治疗方法中的种族不平等：相关数据队列分析。

背景：从全球范围来看，新西兰Aotearoa地区不同种族的胃癌死亡率差异高达6倍，而幽门螺杆菌是主要的可改变的危险因素。本研究调查当前的幽门螺杆菌检测和治疗方法是否公平。材料和方法：研究设计是对相关行政卫生数据进行回顾性队列分析。2015年至2018年，实验室检测数据和药房配药与北部地区健康用户人口数据集（190万）相关联。我们调查了一个人的第一次幽门螺杆菌检测。回归分析比较了年龄、性别和日历年调整后的幽门螺杆菌检测、感染、治疗和再检测率的种族差异。结果：种族不平等在整个临床途径中都存在。与单一欧洲相比，Māori （OR 0.69）和太平洋（OR 0.81）的检测率最低，中东/拉丁美洲/非洲（MELAA）（OR 2.21）和亚洲（OR 2.02）的检测率最高。阳性率最高的是MELAA （RR 2.96, 39%）和太平洋（RR 2.84, 38%），其次是亚洲（RR 1.93, 26%）和Māori （RR 1.71, 23%）。与单一欧洲患者相比，亚洲患者（HR 1.05）、MELAA患者（HR 1.03）和Māori患者（HR 0.98）的治愈率相似，但太平洋患者较低（HR 0.90）。Māori和太平洋公司重新接受检测的可能性是纯欧洲公司的一半。结论：尽管幽门螺杆菌和胃癌的患病率较高，Māori和太平洋地区相对服务不足，检测和治疗率低于欧洲地区。改进指导方针并始终如一地应用这些指导方针以及侧重于公平的测试和治疗方案，可能特别有利于Māori和太平洋解决不公平问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.