Global Prevalence of Helicobacter Pylori Infection and Incidence of Gastric Cancer between 1980 and 2022: A Systematic Review and Meta-Analysis and Analysis of the Global Burden of Disease Study

Abstract

Background: Eradication of Helicobacter pylori (H. pylori) reduces the risk of gastric cancer in infected subjects. We aimed to assess the updated and secular trend of the global prevalence of H. pylori infection in adults and children and to show its relation to that of gastric cancer incidence.

Methods: We performed a systematic review of Pubmed and Embase databases for studies published from Jan 1, 1990, to Sept 30, 2022. We included cross-sectional studies, and control groups in case-control studies to compute the prevalence. Studies focused on special populations known to have a significantly higher prevalence of H. pylori infection were excluded. Meta-analysis under random-effect model was used to calculate overall prevalence and was adjusted by multivariate meta-regression analysis. The incidence rates of gastric cancer were derived from the Global Burden of Disease Study and Cancer Incidence in Five Continents (CI5). This study is registered in PROSPERO, CRD42022324223.

Findings: Of the 16,818 articles screened, a total of 1,517 articles from 106 countries including 6,008,499 participants were eligible for analysis. The crude global prevalence of H. pylori has reduced from 53·8% (95% CI 50·3 to 57·3) before 1990 to 43·7% (95% CI: 42·0 to 45·4) in adults during 2015-2021, but was as still as high as 34·4% (95% CI: 29·4 to 39·7) in children and adolescents during 2015-2021. Secular trend and multivariate regression analyses showed that the global prevalence of H. pylori has declined by 15·9% (95% CI -21·1 to -10·7) over the last three decades in adults, but not in children. Significant reduction of H. pylori prevalence was observed in adults in the Western-Pacific, South-East Asian, and African regions. However, there was no significant reduction in the prevalence of H. pylori in children in any WHO regions. The incidence of gastric cancer has decreased globally and in various countries where the prevalence of H. pylori infection has declined.

Interpretation: The global prevalence of H. pylori infection has declined during the last three decades in adults, but not in children. The decrease in incidence of gastric cancer concomitant with a declining trend in H. pylori prevalence supports a public health drive to reduce the prevalence of H. pylori as a strategy to reduce the incidence of gastric cancer in the population.

Funding: The study was funded by the National Taiwan University Hospital (Grant Number: (Grant Number: NTUH 110-S5106), the Ministry of Science and Technology, Executive Yuan, ROC, Taiwan (Grant Number: MOST 109-2314-B-002-096;MOST 111-2314-B-002-012; MOST 109-2314-B-002-090-MY3), the Ministry of Health and Welfare (Grand Number:MOHW110-TDU-B-211-124002; MOHW111-TDU-B-221-014008), and “Centre of Precision Medicine” of the Higher Education Sprout Project by the Ministry of Education (Grant Number: NTU-109L901401), the National Taiwan University Excellence Research Program Core Consortiums (Grand Number: 110-L1009.110-L1010.110-L1011), and the Liver Disease Prevention & Treatment Research Foundation, Taiwan. EME-O is funded by grants from the Australian Federal Government to the St George and Sutherland Medical Research Foundation.

Declaration of Interest: The authors declare that they have no conflict of interest.

Keywords: Helicobacter pylori, prevalence, gastric cancer, incidence, global, meta-analysis