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Helicobacter pylori infection in the United States beyond NHANES

The Lancet Regional Health - Americas

Updated national estimates of H. pylori prevalence in the US using data sources beyond NHANES. Published in The Lancet Regional Health - Americas.

H. pylori in the United States Beyond NHANES

The Lancet Regional Health – Americas

January 2025 DOI: 10.1016/j.lana.2024.100890

McMahon, M.V., Taylor, C.S., Ward, Z.J., Alarid-Escudero, F., Camargo, M.C., Laszkowska, M., Roa, J., & Yeh, J.M.

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 US mirrors Helicobacter pylori prevalence, the cause of roughly 90% of non-cardia gastric cancers, across racial and ethnic lines. 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from NHANES data collected in the late 1990s and early 2000s, covering only three racial/ethnic groups: two decades on, outdated and incomplete.

The Approach

We went beyond NHANES: a scoping review of PubMed and Embase (through September 2022) yielding 41 publications and 56,845 individuals, data from 1965–2014 across five SEER groups (Hispanic, NHW, NHB, API, AI/AN). We examined how prevalence differs by age and birth cohort to see whether disparities are narrowing, widening, or holding steady.

What We Found

41 Publications synthesized

56,845 Individuals across all studies

8–94% Seroprevalence range across groups and studies

A clear hierarchy emerged: AI/AN carried the highest seroprevalence, NHW the lowest, Hispanic and NHB in between. Estimates ranged from 8% (NHW children) to 94% (some Hispanic samples); AI/AN clustered at 41–82%. Pooled NHANES surveys (17,249 people) showed 43% among Hispanic/NHB adults versus 16% among NHW, a gap our review confirmed has persisted for decades.

Within every group, seroprevalence rose with age and fell in more recent birth cohorts, though the shape varied by population and the evidence was lopsided: 46% of studies came from the West, 41% from the South, none from the Midwest. No study captured all five groups, and API and AI/AN data clustered in a few locales (Alaska, Hawaii, California), limiting generalizability.

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 onto gastric-cancer inequities, yet most evidence is over 20 years old and geographically patchy. Foreign-born status appears to drive some of the highest rates, making immigration and nativity essential variables for future surveillance. Without contemporary data disaggregated by group and origin, targeted prevention for the most-affected communities isn’t possible.

Cite This Work

Cite this work

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. The Lancet Regional Health - Americas. https://doi.org/10.1016/j.lana.2024.100890

@article{mcmahon2024lancet,
  author  = {McMahon, M.V. and Taylor, C.S. and Ward, Z.J. and Alarid-Escudero, F. and Camargo, M.C. and Laszkowska, M. and Roa, J. and Yeh, J.M.},
  title   = {{Helicobacter} pylori Infection in the {United States} Beyond {NHANES}: A Scoping Review of Seroprevalence Estimates by Racial and Ethnic Groups},
  journal = {The Lancet Regional Health - Americas},
  year    = {2024},
  doi     = {10.1016/j.lana.2024.100890},
  url     = {https://jorgeroac.com/publications/papers/peer-reviewed/hpylori-us-beyond-nhanes/}
}

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