Mengmeng Li1,2, Yuanyuan Sun1, Jun Yang3, Catherine de Martel2, Hadrien Charvat2,4, Gary M Clifford2, Salvatore Vaccarella2, Li Wang1. 1. Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing, China. 2. International Agency for Research on Cancer, Lyon, France. 3. Institute for Environmental and Climate Research, Jinan University, Guangzhou, China. 4. Division of Prevention, Centre for Public Health Sciences, National Cancer Centre, Tokyo, Japan.
Abstract
BACKGROUND: Helicobacter pylori (H pylori) is a carcinogen that causes a huge burden of gastric cancer in China. We aimed to evaluate the temporal trends and other sources of variation of H pylori infection in adults from mainland China. MATERIALS AND METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases for articles published from January 1983 to June 2020. We included studies reporting H pylori prevalence in adults and then applied random effect meta-analyses to obtain pooled prevalence estimates for all studies and subgroups. Sources of heterogeneity were investigated by moderator analysis, and time trends were assessed through random effect meta-regression. RESULTS: Of the 2121 studies identified, 98 were eligible for inclusion. The pooled estimate of 670 572 participants from 26 provinces during 1983-2018 was 49.6% (95% CI: 46.9%, 52.4%). H pylori prevalence varied considerably, ranging from 20.6% to 81.8%. Periods, urban/rural status, detection method, and study design explained 18.8%, 24.0%, 17.8%, and 30.4% of the heterogeneity, respectively. Overall, H pylori prevalence declined by -0.9% (95% CI: -1.1%, -0.6%) annually. Consistent declines in prevalence were observed by sex, age, and study characteristics. CONCLUSIONS: Helicobacter pylori prevalence is slowly decreasing over time in mainland China, but the low declining speed is not enough to have a major impact on gastric cancer incidence for many years. The time trends and the large heterogeneity should be taken into account when conducting regional comparisons, disease burden estimations, and customized strategy making.
BACKGROUND:Helicobacter pylori (H pylori) is a carcinogen that causes a huge burden of gastric cancer in China. We aimed to evaluate the temporal trends and other sources of variation of H pylori infection in adults from mainland China. MATERIALS AND METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases for articles published from January 1983 to June 2020. We included studies reporting H pylori prevalence in adults and then applied random effect meta-analyses to obtain pooled prevalence estimates for all studies and subgroups. Sources of heterogeneity were investigated by moderator analysis, and time trends were assessed through random effect meta-regression. RESULTS: Of the 2121 studies identified, 98 were eligible for inclusion. The pooled estimate of 670 572 participants from 26 provinces during 1983-2018 was 49.6% (95% CI: 46.9%, 52.4%). H pylori prevalence varied considerably, ranging from 20.6% to 81.8%. Periods, urban/rural status, detection method, and study design explained 18.8%, 24.0%, 17.8%, and 30.4% of the heterogeneity, respectively. Overall, H pylori prevalence declined by -0.9% (95% CI: -1.1%, -0.6%) annually. Consistent declines in prevalence were observed by sex, age, and study characteristics. CONCLUSIONS:Helicobacter pylori prevalence is slowly decreasing over time in mainland China, but the low declining speed is not enough to have a major impact on gastric cancer incidence for many years. The time trends and the large heterogeneity should be taken into account when conducting regional comparisons, disease burden estimations, and customized strategy making.
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