Seroprevalence of Helicobacter pylori infection among asymptomatic patients served by a safety-net healthcare system.

Abstract

Background and aims: Helicobacter pylori screening and eradication is a cost-effective strategy for primary gastric cancer prevention in high-risk populations outside the U.S. There is a paucity of population-based H. pylori seroprevalence data available in high-risk U.S. groups, particularly data for low income, uninsured patient populations.

Methods: We used data from a cross-sectional study of a largely underserved, immigrant, and minority patient population. Inclusion criteria included asymptomatic individuals aged 30-65 years without prior H. pylori testing or treatment. Consented patients completed a study survey and a blood draw to screen for H. pylori using IgG serology. We calculated seroprevalence overall and within sub-groups of the study population.

Results: Screening for H. pylori infection was completed in 1,021 individuals. Participants had a mean age of 47.5 years, 69.9% female and 88.7% Hispanic individuals. Overall, 63.9% (95% confidence interval [CI] 60.9-66.8%) of participants were seropositive for H. pylori. H. pylori seroprevalence was similar across age groups, but was higher among males (69.1%, 95% CI 63.9-74.2%) than females (61.6%, 95% CI 58.1-65.2%). Seroprevalence of H. pylori was highest for Hispanic(65.9%, 95% CI 62.8-69.0%) and lowest for non-Hispanic White (45.0%, 95% CI 23.2-66.8%) individuals. H. pylori seroprevalence was highest among individuals born in Central America (75.1%). Risk for infection was no different between second and third generation immigrants.

Conclusion: In this population-based study, almost two-thirds of asymptomatic patients were seropositive for H. pylori. Prevalence was over 40% among all sub-groups. Screening solely based on race and ethnicity may inadvertently exacerbate disparities by overlooking confounding factors for infection like low socioeconomic status and regional exposures.