Helicobacter pylori infection in the United States beyond NHANES
The Lancet Regional Health - Americas
H. pylori in the United States Beyond NHANES
Golden Gate at dusk — San Francisco Bay San Francisco · California The north tower of the Golden Gate Bridge rises above the fog layer as the city lights come on behind it. The Bay Area as the threshold between what is measured and what remains hidden beneath the surface.
The Problem
Gastric cancer in the United States follows a stark pattern: racial and ethnic disparities in incidence mirror those long seen in Helicobacter pylori prevalence – the cause of roughly 90% of non-cardia gastric cancers. Yet the most recent national estimates come from NHANES data collected in the late 1990s and early 2000s, covering only three racial/ethnic groups. Two decades on, the picture is both outdated and incomplete.
The Approach
We went beyond NHANES. Searching PubMed and Embase (December 2021, updated September 2022), we compiled a scoping review of 41 publications representing 56,845 individuals with data collected between 1965 and 2014, stratified across five SEER racial/ethnic groups: Hispanic, Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Asian/Pacific Islander (API), and American Indian/Alaska Native (AI/AN). We then examined how prevalence differs by age and birth cohort to see whether disparities are narrowing, widening, or holding steady.
What We Found
A clear hierarchy emerged – AI/AN populations carried the highest seroprevalence, NHW the lowest, with Hispanic and NHB groups in between. Estimates ran from as low as 8% (NHW children) to as high as 94% in some Hispanic samples; AI/AN studies clustered between 41% and 82%. The pooled NHANES surveys (17,249 people) showed 43% among Hispanic and NHB adults versus 16% among NHW – the same gap our wider review confirmed has persisted across decades.
Within every group, seroprevalence rose with age and fell in more recent birth cohorts – but the shape of those trends differed by population, and the evidence was lopsided. Nearly half the studies came from the West (46%) and South (41%); the Midwest contributed none directly. No single study captured all five groups, and API and AI/AN data were concentrated in a few locales (Alaska, Hawaii, California), limiting how far the trends generalize.
Age and birth-cohort trends in H. pylori seroprevalence by race/ethnicity (Hispanic, NHW, NHB, API, AI/AN). Circles = published studies; triangles = NHANES.
Why It Matters
Persistent disparities in H. pylori prevalence map directly onto gastric-cancer inequities – yet most of the evidence is over 20 years old and geographically patchy. Foreign-born status appears to drive some of the highest rates, pointing to immigration and nativity as essential variables for future surveillance. Without comprehensive, contemporary data disaggregated by group and origin, we cannot design the targeted prevention the most-affected communities need.
Citation
McMahon, M.V., Taylor, C.S., Ward, Z.J., Alarid-Escudero, F., Camargo, M.C., Laszkowska, M., Roa, J., & Yeh, J.M. (2024). Helicobacter pylori infection in the United States beyond NHANES: a scoping review of seroprevalence estimates by racial and ethnic groups. Lancet Regional Health. Americas, 41, 100890. DOI: 10.1016/j.lana.2024.100890
Citation
@article{m.v.2025,
author = {M.V. , McMahon and C.S. , Taylor and Z.J. , Ward and F. ,
Alarid-Escudero and M.C. , Camargo and M. , Laszkowska and J. , Roa
and J.M. , Yeh},
title = {Helicobacter Pylori Infection in the {United} {States} Beyond
{NHANES}},
journal = {The Lancet Regional Health - Americas},
date = {2025-01-01},
url = {https://jorgeroac.com/publications/papers/peer-reviewed/hpylori-us-beyond-nhanes/},
doi = {10.1016/j.lana.2024.100890},
langid = {en}
}