Time Trends and Demographic Disparities in Helicobacter pylori Burden in a Large, Community-Based Population in the United States

Abstract

There are minimal recent population-based data on the epidemiology of Helicobacter pylori (H.pylori) in the United States. This retrospective cohort study evaluated H.pylori positivity rates in adult members of a large, community-based US population in 2000-2019. Time trends, demographic disparities, and birth cohort effects on H.pylori test positivity rates were analyzed. Among 751,322 individuals tested for H.pylori, the overall nonserological and serological test positivity rates were 18.2% (95% confidence interval [CI], 18.1%-18.4%) and 36.8% (95% CI, 36.6%-36.9%), respectively. Nonserological positivity rate (95% CI) was significantly higher among Asian (23.2% [22.8%-23.6%]), Black (25.1% [24.4%-25.8%]), and Hispanic (28.1% [27.7%-28.5%]) individuals than non-Hispanic White individuals (10.0% [9.8%-10.2%]), and was significantly higher among individuals with a non-English language preference (32.9% [32.3%-33.5%]) than those with English language preference (15.8% [15.6%-15.9%]). Patterns were similar for serological positivity, although with substantially higher rates. Serological positivity rates decreased over 2 decades but nonserological positivity rates initially decreased and then stabilized over the past decade. There was a significant decrease in both nonserological and serological positivity rates from older to younger birth cohorts. Older age, non-White race or Hispanic ethnicity, male sex, and non-English language preference were associated with high odds of H.pylori positivity. The burden of H.pylori decreased over 2 decades, although the rates of active infection plateaued over the past decade in a diverse, community-based US population, likely attributable to birth cohort effects and demographic changes. Asian, Black, and Hispanic individuals had 2-3-fold higher rates of active H.pylori infection than non-Hispanic White individuals. These findings should inform targeted screening and eradication of H.pylori in high-risk US populations.