幽门螺杆菌在非裔美国和西班牙裔退伍军人中的患病率仍然很高。
The Prevalence of Helicobacter pylori Remains High in African American and Hispanic Veterans.
作者信息
Nguyen Theresa, Ramsey David, Graham David, Shaib Yasser, Shiota Seiji, Velez Maria, Cole Rhonda, Anand Bhupinderjit, Vela Marcelo, El-Serag Hashem B
机构信息
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
出版信息
Helicobacter. 2015 Aug;20(4):305-15. doi: 10.1111/hel.12199. Epub 2015 Feb 17.
BACKGROUND
Helicobacter pylori in the United States has been declining in the 1990s albeit less so among blacks and Hispanics. As the socioeconomic status of racial groups has evolved, it remains unclear whether the prevalence or the racial and ethnic disparities in the prevalence of H. pylori have changed.
METHODS
This is a cross-sectional study from a Veteran Affairs center among patients aged 40-80 years old who underwent a study esophagogastroduodenoscopy with gastric biopsies, which were cultured for H. pylori irrespective of findings on histopathology. Positive H. pylori was defined as positive culture or histopathology (stained organism combined with active gastritis). We calculated age-, race-, and birth cohort-specific H. pylori prevalence rates and examined predictors of H. pylori infection in logistic regression models.
RESULTS
We analyzed data on 1200 patients; most (92.8%) were men and non-Hispanic white (59.9%) or black (28.9%). H. pylori was positive in 347 (28.9%) and was highest among black males aged 50-59 (53.3%; 44.0-62.4%), followed by Hispanic males aged 60-69 (48.1%; 34.2-62.2%), and lowest in non-Hispanic white males aged 40-49 (8.2%; 2.7-20.5%). In multivariate analysis, age group 50-59 was significantly associated with H. pylori (adjusted odds ratio (OR), 2.32; 95% confidence interval (CI), 1.21-4.45) compared with those aged 40-49, and with black race (adjusted OR, 2.57; 95% CI, 1.83-3.60) and Hispanic ethnicity (adjusted OR, 3.01; 95% CI, 1.70-5.34) compared with non-Hispanic white. Irrespective of age group, patients born during 1960-1969 had a lower risk of H. pylori (adjusted OR, 0.45; 95% CI, 0.22-0.96) compared to those born in 1930-1939. Those with some college education were less likely to have H. pylori compared to those with no college education (adjusted OR 0.51; 95% CI, 0.37-0.69).
CONCLUSION
Among veterans, the prevalence of active H. pylori remains high (28.9%) with even higher rates in blacks and Hispanics with lower education levels.
背景
20世纪90年代美国幽门螺杆菌感染率呈下降趋势，不过在黑人和西班牙裔人群中下降幅度较小。随着不同种族社会经济地位的演变，幽门螺杆菌感染率及其种族差异是否发生变化尚不清楚。
方法
这是一项在退伍军人事务中心开展的横断面研究，研究对象为40至80岁接受食管胃十二指肠镜检查及胃活检的患者，无论组织病理学检查结果如何，均对胃活检样本进行幽门螺杆菌培养。幽门螺杆菌阳性定义为培养阳性或组织病理学阳性（发现染色菌并伴有活动性胃炎）。我们计算了特定年龄、种族和出生队列的幽门螺杆菌感染率，并在逻辑回归模型中分析了幽门螺杆菌感染的预测因素。
结果
我们分析了1200例患者的数据；大多数患者（92.8%）为男性，其中非西班牙裔白人占59.9%，黑人占28.9%。347例（28.9%）患者幽门螺杆菌检测呈阳性，其中50至59岁黑人男性的感染率最高（53.3%；44.0 - 62.4%），其次是60至69岁西班牙裔男性（48.1%；34.2 - 62.2%），40至49岁非西班牙裔白人男性的感染率最低（8.2%；2.7 - 20.5%）。多因素分析显示，与40至49岁人群相比，50至59岁年龄组与幽门螺杆菌感染显著相关（调整比值比（OR）为2.32；95%置信区间（CI）为1.21 - 4.45）；与非西班牙裔白人相比，黑人种族（调整OR为2.57；95% CI为1.83 - 3.60）和西班牙裔种族（调整OR为3.01；95% CI为1.70 - 5.34）与幽门螺杆菌感染显著相关。无论年龄组如何，1960至1969年出生的患者感染幽门螺杆菌的风险低于1930至1939年出生的患者（调整OR为0.45；95% CI为0.22 - 0.96）。与未接受过大学教育的患者相比，接受过一些大学教育的患者感染幽门螺杆菌的可能性较小（调整OR为0.51；95% CI为0.37 - 0.69）。
结论
在退伍军人中，活动性幽门螺杆菌感染率仍然较高（28.9%），在受教育程度较低的黑人和西班牙裔人群中感染率更高。
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