Seroprevalence of Helicobacter pylori Infection Among Asymptomatic Patients Served by a Safety-Net Healthcare System

Helicobacter pylori screening and eradication is a cost-effective strategy for primary gastric cancer prevention in high-risk populations outside the United States. There is a paucity of population-based H pylori seroprevalence data available in high-risk U.S. groups, particularly data for low-income, uninsured patient populations.

We used data from a cross-sectional study of a largely underserved, immigrant, and minority patient population. Inclusion criteria included asymptomatic individuals 30-65 years of age without prior H pylori testing or treatment. Consented patients completed a study survey and a blood draw to screen for H pylori using IgG serology. We calculated seroprevalence overall and within subgroups of the study population.

Screening for H pylori infection was completed in 1021 individuals. Participants had a mean age of 47.5 years and were 69.9% female, and 88.7% were Hispanic individuals. Overall, 63.9% (95% confidence interval [CI], 60.9%-66.8%) of participants were seropositive for H pylori. H pylori seroprevalence was similar across age groups but was higher among males (69.1%; 95% CI, 63.9%-74.2%) than females (61.6%; 95% CI, 58.1%-65.2%). Seroprevalence of H pylori was highest for Hispanic (65.9%; 95% CI, 62.8%-69.0%) and lowest for non-Hispanic White (45.0%; 95% CI, 23.2%-66.8%) individuals. H pylori seroprevalence was highest among individuals born in Central America (75.1%). Risk for infection was no different between second- and third-generation immigrants.

In this population-based study, almost two-thirds of asymptomatic patients were seropositive for H pylori. Prevalence was over 40% among all subgroups. Screening solely based on race and ethnicity may inadvertently exacerbate disparities by overlooking confounding factors for infection like low socioeconomic status and regional exposures.