Large-scale, national, family-based epidemiological study on Helicobacter pylori infection in China: the time to change practice for related disease prevention

Abstract

Background and aims: Current practice on Helicobacter pylori infection mostly focuses on individual-based care in the community, but family-based H. pylori management has recently been suggested as a better strategy for infection control. However, the family-based H. pylori infection status, risk factors and transmission pattern remain to be elucidated.

Methods: From September 2021 to December 2021, 10 735 families (31 098 individuals) were enrolled from 29 of 31 provinces in mainland China to examine family-based H. pylori infection, related factors and transmission pattern. All family members were required to answer questionnaires and test for H. pylori infection.

Results: Among all participants, the average individual-based H. pylori infection rate was 40.66%, with 43.45% for adults and 20.55% for children and adolescents. Family-based infection rates ranged from 50.27% to 85.06% among the 29 provinces, with an average rate of 71.21%. In 28.87% (3099/10 735) of enrolled families, there were no infections; the remaining 71.13% (7636/10 735) of families had 1-7 infected members, and in 19.70% (1504/7636), all members were infected. Among 7961 enrolled couples, 33.21% had no infection, but in 22.99%, both were infected. Childhood infection was significantly associated with parental infection. Independent risk factors for household infection were infected family members (eg, five infected members: OR 2.72, 95% CI 1.86 to 4.00), living in highly infected areas (eg, northwest China: OR 1.83, 95% CI 1.57 to 2.13), and large families in a household (eg, family of three: OR 1.97, 95% CI 1.76 to 2.21). However, family members with higher education and income levels (OR 0.85, 95% CI 0.79 to 0.91), using serving spoons or chopsticks, more generations in a household (eg, three generations: OR 0.79, 95% CI 0.68 to 0.92), and who were younger (OR 0.57, 95% CI 0.46 to 0.70) had lower infection rates (p<0.05).

Conclusion: Familial H. pylori infection rate is high in general household in China. Exposure to infected family members is likely the major source of its spread. These results provide supporting evidence for the strategic changes from H. pylori individual-based treatment to family-based management, and the notion has important clinical and public health implications for infection control and related disease prevention.

Keywords: GASTRIC CANCER; GASTRIC PRE-CANCER; HELICOBACTER PYLORI - EPIDEMIOLOGY; HELICOBACTER PYLORI - GASTRITIS; HELICOBACTER PYLORI INFECTION.

Figure 1

Flow chart of household and individual enrolment processes. (A) These households failed to submit, or submitted incomplete questionnaires, the exact number of family members in these households were not available. (B) Infected household is defined as a household with at least one Helicobacter pylori-infected family member. (C) Uninfected household is defined as a household without any H. pylori-infected family member.

Figure 2

Helicobacter pylori infection status of the enrolled families. (A) H. pylori infection status of enrolled participants and their infection rates in different age groups. Left y axis represents the number of participants enrolled, and right y axis represents the percentage of their infection rates, x axis indicates different age groups. (B, C) figure 2B indicates H. pylori infection status of 10 735 enrolled families, and figure 2C indicates stratified 7636 H. pylori-infected families. y axis represents family size, which ranges from 2 to 7 (or more) persons, and x axis represents the number of infected persons within the household. Numbers within square represents the number of infected families; percentage numbers within the bracket and curve lines indicate the percentage of infected families in the same family size groups. Infected family: at least one person in the family was infected; non-infected family: all members in the family were not infected. Children: participant’s age is less than 18 years for short, including children and adolescents.

Figure 3

Stratified analysis of Helicobacter pylori infection in the enrolled families. (A) Correlation of annual household income, average family size and proportion of infected person in different household income groups. Left: y axis represents average family size, and right: y axis represents average percentage of infected participants, and x axis indicates annual household income. *p<0.05 when compared with household income < ¥100 000 group. (B) Correlation of stratified annual household income and infection rate in 10 735 families. The y axis represents percentage of families, and x axis indicates annual household income. ***p<0.001 when compared with household income < ¥100 000 group; NS, not significant when these groups were compared with each other, p>0.05. (C) Distribution of couples/generations number per household in 10 735 enrolled families; y axis represents the number of family, and x axis represents the number of couples/generations within the family. (D) Infection status of the total 7961 couples; y axis represents the number of couples, and x axis indicates the infection status of these couples. (E) Correlation of couple cohabitation time and H. pylori infection rate of 7961 couples. The y axis represents percentage of couples, and x axis indicates couple cohabitation time (years). *p<0.05 and **p<0.01, when compared with 0–5 years cohabitation group; NS, not significant when these groups were compared with each other, p>0.05. (F) Correlation of annual household income and couple infection status. The y axis represents percentage of couples, and x axis indicates annual household income. *p<0.05 when compared with household income <¥100 000 group; NS when these groups were compared with each other, p>0.05. (G) The total 3781 children’s cohabitation status with their parents, y axis represents children number, and x axis indicates children’s cohabitation status with their parents, the percentages inside the bracket are the percentages of the total children number. (H) Parental infection status of 1976 children who cohabitated with them, y axis represents children number, and x axis indicates H. pylori infection status of these parents. (I) Correlation of parental infection status and children infection rate, y axis represents the infection rate, x axis indicates H. pylori infection status of these parents. **p<0.01, ***p<0.001 when infection rates between the two groups were compared.