Prevalence of Helicobacter pylori Infection among the General Population in Guangxi, China

Introduction

Helicobacter pylori (HP) is a spiral-shaped, Gram-negative bacterium that primarily colonizes the gastric mucosa and is recognized as a leading cause of gastric cancer.¹ The prevalence of HP infection varies significantly among different regions and populations.² Worldwide, it is estimated that over half of the global population is infected.³ While some countries have seen a decline in HP infection rates in recent years, others have experienced an increase.⁴ For instance, in the United States, the prevalence of HP infection has been decreasing steadily over time.⁵ Currently, approximately 24.5% of individuals under 60 years of age and 27.1% of those aged over 60 are estimated to be infected.⁶

The prevalence of HP infection in China has been reported to range from 41.5% to 72.3%, with a significant decline observed from 60.5% to 52.2% after the year 2000.⁷ Despite these findings, comprehensive studies investigating the prevalence and associated risk factors of HP infection in Guangxi Zhuang Autonomous Region (abbreviated as Guangxi), China, a region with a population of 57.48 million as of 2023, remain insufficient. Previous research has identified factors such as age and occupation as significant contributors to variations in infection rates.⁸ To address this gap, we conducted a large-scale study with 2,729 participants to evaluate HP infection rates across genders, age groups, and occupational categories in Guangxi, China. The outcomes of this study provide essential insights that can guide the development of effective public health strategies for the prevention and eradication of HP infection in China.

Methods

Results

Discussion

This study determined that the overall HP infection rate in China is 31.4%, with infection rates of 31.5% among males and 31.2% among females. The most recent data on HP infection in the Chinese population comes from a meta-analysis conducted in 2022, which reported a prevalence of 44.2%.⁹ In recent years, HP infection rates across different regions of China have ranged from 35.8% to 66.4%.¹⁰ The lower HP infection rate observed in this study suggests a further decline in prevalence across the country. HP infection is influenced by various factors, as demonstrated by a nearly 20-year analysis covering multiple regions of mainland China. The findings indicate that lifestyle habits, such as meat consumption, as well as factors like per capita gross domestic product (GDP) and annual average humidity, contribute to regional differences in HP infection rates.¹¹ Guangxi, located in south-central China and bordering Vietnam to the southwest, currently reports the lowest HP infection rate in the country.

Our study revealed that HP infection rates increase with age in China, consistent with trends observed in most developing countries and some developed ones.¹² For instance, individuals over the age of 60 may exhibit infection rates 2-3 times higher than those under the age of 20.¹³ This disparity can be attributed to the elderly having more frequent exposure to contaminated water sources, unclean food, or shared utensils. Additionally, weakened immune function in older adults makes them more susceptible to long-term colonization.¹⁴ Reports indicate that infection rates among individuals aged 40 and above in developing countries, such as India, can range from 50% to 80%.¹⁵ In contrast, developed countries, including the United States and Western Europe, show lower infection rates among young people (<20%), though older adults may still have elevated rates due to historical exposure.^16,17 Consequently, elderly individuals infected with HP are at a higher risk of developing gastric cancer.¹⁸ Interestingly, in a few developed countries, such as Australia, extremely low childhood infection rates result in lower infection rates among the elderly population compared to those in middle age.¹⁹

In this study, the population was categorized into four occupational groups: civil servants, company employees, teachers, and others, based on the nature of work in China. The findings revealed that HP infection rates were lowest among civil servants, higher among teachers. The relationship between HP infection and occupation is a compelling topic. For instance, a study in Portugal reported a lower prevalence of HP infection among sewage workers (16.7%) compared to miners (48.1%).²⁰ Occupational classification of HP infection varies across countries due to differences in working conditions, and some classifications may be less applicable universally. In China, civil servants typically have stable jobs with minimal travel and socializing requirements. In contrast, company employees often engage in high-intensity work involving frequent travel and extensive social interactions. Teaching in China is a profession with significant work pressure, requiring regular assessments and coping with various challenges in recent years. As a result, our analysis indicates that Chinese teachers are a high-risk group for HP infection and should be prioritized for targeted interventions.