Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
Helicobacter. 2023 Aug;28(4):e12988. doi: 10.1111/hel.12988. Epub 2023 May 29.
Japan became the world's first country to cover Helicobacter pylori eradication for chronic gastritis under its National Health Insurance (NHI) system in February 2013. Thereafter, H. pylori eradication dramatically increased and gastric cancer deaths began to decrease in Japan. However, the details of gastric cancer deaths and its prevention in the very elderly have not been fully elucidated.
We analyzed the temporal trend of gastric cancer deaths referencing data from Ministry of Health, Labour and Welfare reports and "Cancer Statistics in Japan-2021" and assessed the numbers of H. pylori test and gastric cancer screening using a national database and a report of cancer screening in Shimane Prefecture, respectively.
Although gastric cancer deaths in total population have clearly decreased since 2013, those in people aged 80 years and older are still increasing. People aged 80 years and older represent 9% of the total population and accounted for half of all gastric cancer deaths in 2020. The numbers of H. pylori eradication and gastric cancer screening in people aged 80 years and older were 25% and 25% of those in other generations, respectively.
In spite of a dramatic increase in H. pylori eradication and a clear decrease in gastric cancer deaths in Japan, gastric cancer deaths in people aged 80 years and older are increasing. This might be due to fewer H. pylori eradication in the elderly than in other generations, indicating the difficulty of gastric cancer prevention in the very elderly.
2013 年 2 月，日本成为全球首个将国家健康保险（NHI）系统覆盖用于治疗慢性胃炎的幽门螺杆菌（H. pylori）根除的国家。此后，日本的 H. pylori 根除率大幅上升，胃癌死亡率开始下降。然而，关于非常高龄人群的胃癌死亡及其预防的细节尚未完全阐明。
我们参考厚生劳动省报告和《日本癌症统计-2021》中的数据，分析了胃癌死亡的时间趋势，并分别使用国家数据库和岛根县癌症筛查报告评估了 H. pylori 检测和胃癌筛查的数量。
尽管自 2013 年以来，总人口的胃癌死亡率明显下降，但 80 岁及以上人群的死亡率仍在上升。80 岁及以上人群占总人口的 9%，占 2020 年所有胃癌死亡人数的一半。80 岁及以上人群的 H. pylori 根除和胃癌筛查数量分别为其他年龄段的 25%和 25%。
尽管日本的 H. pylori 根除率大幅上升，胃癌死亡率明显下降，但 80 岁及以上人群的胃癌死亡率仍在上升。这可能是由于老年人的 H. pylori 根除率低于其他年龄段，表明非常高龄人群的胃癌预防存在困难。
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