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Master of Public Health

Helicobacter pylori burden in the United States according to individual demographics and geography: a nationwide analysis of the Veterans Healthcare System

AUTHORS

Shah SC , Halvorson AE , Lee D , Bustamante R , McBay B , Gupta R , Denton J , Dorn C , Wilson O , Peek R , Gupta S , Liu L , Hung A , Greevy R , Roumie CL , . Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2023 5 26; ().

ABSTRACT

BACKGROUND AND AIMS: There are no contemporary large-scale studies evaluating the burden of Helicobacter pylori in the United States according to detailed demographics. The primary objective was to evaluate H. pylori positivity in a large national healthcare system according to individual demographics and geography.

METHODS: We conducted a nationwide retrospective analysis of adults in the Veterans Health Administration who completed H. pylori testing between 1999-2018. The primary outcome was H. pylori positivity overall, as well as according to zip code-level geography, race, ethnicity, age, sex, and time period.

RESULTS: Among 913,328 individuals (mean 58.1 years, 90.2% male) included between 1999-2018, H. pylori was diagnosed in 25.8%. Positivity was highest in non-Hispanic Black (median 40.2%; 95% CI, 40.0%-40.5%) and Hispanic (36.7%; 95% CI, 36.4%-37.1%) individuals, and lowest in non-Hispanic White individuals (20.1%; 95% CI, 20.0%-20.2%). While H. pylori positivity declined in all racial and ethnic groups over the timeframe, the disproportionate burden of H. pylori in non-Hispanic Black and Hispanic compared to non-Hispanic White individuals persisted. Approximately 4.7% of the variation in H. pylori positivity was explained by demographics, with race and ethnicity accounting for the vast majority.

CONCLUSIONS: The burden of H. pylori is substantial in the United States among veterans. These data should 1) motivate research aimed at better understanding why marked demographic differences in H. pylori burden persist so that mitigating interventions may be implemented, and 2) guide resource allocation to optimize H. pylori testing and eradication in high-risk groups.

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