title: Sociodemographic determinants of prevalence and incidence of Helicobacter pylori infection in Portuguese adults.
abstract: BACKGROUND
  Understanding the determinants of Helicobacter pylori infection in adults is essential to predict the burden of H. pylori-related diseases. We aimed to estimate the prevalence and incidence of H. pylori infection and to identify its major sociodemographic correlates in an urban population from the North of Portugal.
  
  
  METHODS
  A representative sample of noninstitutionalized adult inhabitants of Porto (n = 2067) was evaluated by ELISA (IgG) and a subsample (n = 412) was tested by Western Blot to assess infection with CagA-positive strains. Modified Poisson and Poisson regression models were used to estimate crude and sex-, age-, and education-adjusted prevalence ratios (PR) and incidence rate ratios (RR), respectively.
  
  
  RESULTS
  The prevalence of H. pylori infection was 84.2% [95% confidence interval (95%CI): 82.4-86.1]. It increased across age-groups in the more educated subjects, (18-30 years: 72.6%; ≥71 years: 88.1%; p for trend <0.001) and decreased with education in the younger (≤4 schooling years: 100.0%; ≥10 schooling years: 72.6%; p for trend <0.001). Living in a more deprived neighborhood was associated with a higher prevalence of infection, only in the younger (PR = 1.20, 95%CI: 1.03-1.38) and more educated participants (PR = 1.15, 95%CI: 1.03-1.29). Among the infected, the proportion with CagA-positive strains was 61.7% (95%CI: 56.6-66.9). The incidence rate was 3.6/100 person-years (median follow-up: 3 years; 95%CI: 2.1-6.2), lower among the more educated (≥10 vs ≤9: RR = 0.25, 95%CI: 0.06-0.96). The seroreversion rate was 1.0/100 person-years (95%CI: 0.6-1.7).
  
  
  CONCLUSIONS
  The prevalence of infection among adults is still very high in Portugal, suggesting that stomach cancer rates will remain high over the next few decades.
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Bastos
authors.forename: Bárbara
authors.initials: B
authors.lastname: Peleteiro
authors.forename: Rita
authors.initials: R
authors.lastname: Barros
authors.forename: Luís
authors.initials: L
authors.lastname: Alves
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.forename: Maria
authors.initials: M
authors.lastname: de Fátima Pina
authors.forename: Hugo
authors.initials: H
authors.lastname: Pinto
authors.forename: Sandra
authors.initials: S
authors.lastname: Carvalho
authors.forename: Ana
authors.initials: A
authors.lastname: Marinho
authors.forename: João T
authors.initials: JT
authors.lastname: Guimarães
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Henrique
authors.initials: H
authors.lastname: Barros
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D055815:Young Adult
keywords: Helicobacter pylori infection; Portugal; incidence; prevalence