Risk Factors and Incidence of Gastric Cancer After Detection of Helicobacter pylori Infection: A Large Cohort Study
Abstract
Background & Aims: Nearly all studies of gastric adenocarcinoma in the United States have relied on national cancer databases, which do not include data on Helicobacter pylori infection, the most well-known risk factor for gastric cancer. We collected data from a large cohort of patients in the United States to calculate the incidence of and risk factors for non-proximal gastric adenocarcinomas after detection of H pylori. Secondary aims included identifying how treatment and eradication affect cancer risk. Methods: We performed a retrospective cohort study, collecting data from the Veterans Health Administration on 371,813 patients (median age, 62 years; 92.3% male) who received a diagnosis of H pylori infection from January 1, 1994 through December 31, 2018. The primary outcome was a diagnosis of distal gastric adenocarcinoma 30 days or more after detection of H pylori infection. We performed time to event with competing risk analysis (death before cancer a competing risk). Results: The cumulative incidence of cancer at 5, 10, and 20 years after detection of H pylori infection was 0.37%, 0.5%, and 0.65%, respectively. Factors associated with cancer included older age at time of detection of H pylori infection (sub-hazard ratio [SHR], 1.13; 95% CI, 1.11–1.15; P<.001), black/African American race (SHR, 2.00; 95% CI, 1.80–2.22), Asian race (SHR, 2.52; 95% CI, 1.64–3.89) (P<.001 for race), Hispanic or Latino ethnicity (SHR, 1.59; 95% CI, 1.34–1.87; P<.001), or history of…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 371,813 participants or records.
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