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Environmental risk factors associated with Helicobacter pylori seroprevalence in the United States: A cross-sectional analysis of NHANES data
Citation:
Krueger, W., E Hilborn, R. Converse, AND Tim Wade. Environmental risk factors associated with Helicobacter pylori seroprevalence in the United States: A cross-sectional analysis of NHANES data. EPIDEMIOLOGY AND INFECTION. Cambridge University Press, New York, NY, 143(12):2520-31, (2015).
Impact/Purpose:
Helicobacter pylori is a potentially waterborne pathogen that is on EPA's contaminant candidate list (CCL) for drinking water regulation. It is a common infection that is associated with long term health conditions including gastric cancer and ulcers. The purpose of this study was to evaluate the risk factors for infection with H. pylori using a nationally representative database. Well water usage and occupational contact with soil were associated with H.pylori infection as were poor health and crowded living conditions.
Description:
Background: Helicobacter pylori imparts a considerable burden to public health. Infections are mainly acquired in childhood and can lead to chronic diseases, including peptic ulcer and gastric cancer. The bacterium subsists in water, but the environment’s role in H. pylori transmission remains poorly understood. The nationally representative National Health and Nutrition Examination Survey (NHANES) was examined for environmental risk factors associated with H. pylori seroprevalence.Methods: H. pylori serology data from Continuous NHANES 1999-2000 were examined and weighted to represent the US population. Multivariable logistic regression estimated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations with seropositivity.Results: 2,504 (25.4%) of 7,493 participants were seropositive. Self-reported general health condition was inversely associated with seropositivity. Among participants <20 years old, seropositivity was associated with having a well as the source of home tap water (AOR=1.7; CI=1.1-2.6) and living in a more crowded home (AOR=2.3; CI=1.5-3.7). Among adults >20 years old, while H. pylori seropositivity was not associated with well water or crowded living conditions, adults in soil-related occupations had higher odds of seropositivity compared to those in non-soil related occupations (AOR=1.9; CI=1.2-2.9). Conclusions: Environmental exposures (well water usage and occupational contact with soil) play a role in H. pylori transmission. A disproportionate burden of infection is associated with poor health and crowded living conditions, but risks vary by age and race/ethnicity. These findings provide additional insight regarding risk factors for H. pylori transmission and could help inform interventions to reduce the burden of infections in the United States.
