Predictors of H. pylori infection in a safety-net hospital in Arizona


Objective: The purpose of this study was to determine the risk factors associated with having H. pylori infection as proven by endoscopic biopsy at Maricopa Medical Center (MMC), a safety-net hospital in phoenix, Arizona which serves primarily patients with limited financial and insurance resources. Methods: A total of 1116 biopsies were identified in a Department of Pathology database searched from November 2004 to March 2013. To be included, the subjects had to have an endoscopy with gastric biopsy. After the inclusion criteria were applied, 282 control subjects without histological evidence of H. pylori infection and 256 cases with histological evidence of H. pylori infection were identified. Patient charts were reviewed to extract information on variables collected for this study. Results: The mean age of cases and controls was 50.5 and 52.3 years respectively. The BMI of the cases and controls was 28.1 and 28.0 respectively. The mean number of upper endoscopic exams performed was 1.3 in cases and 1.4 in controls respectively. Potential predictors examined were gender, history of drug abuse, history of alcohol abuse, chronic pain medication use, smoking, employment status, outpatient vs. inpatient upper endoscopy exam, language spoken (English, Spanish, or bilingual), race/ ethnicity, type of insurance, heart burn, dysphagia, abdominal pain, gastroduodenal ulcers, intestinal metaplasia, and having vs. not having a primary care physician. Based on univariate analyses, having a gastroduodenal ulcer, having a history of abdominal pain, Hispanic race, government insurance status, self-pay insurance status, and speaking Spanish only were found to be significantly related to having H. pylori infection. These variables were next entered into a multivariate analysis. The multivariate analysis revealed that gastroduodenal ulcer, abdominal pain, Hispanic race and self-pay insurance status remained significant predictors of H. pylori infection. For the last 119 subjects, information regarding the country of their birth was available. These 119 subjects were separately analyzed. Country of birth, age, sex, Hispanic race, self-pay insurance status, Spanish speaker, and having government insurance were included in a multivariate analysis. Twenty seven percent of patients without H. pylori were born in the US, compared to fifty eight percent H. pylori positive patients who were born outside of the US. Conclusion: Hispanics are at high risk for H. pylori infection. In a multivariate model, patients with H. pylori were found to have a higher risk of ulcers, Hispanic race, abdominal pain and self-insurance status. When self-insurance and Hispanic race were included in another analysis with place of birth, only birth outside US remained significant.

Share and Cite:

Boddu, S. , Drachman, D. , Ravi, J. and Nadir, A. (2013) Predictors of H. pylori infection in a safety-net hospital in Arizona. Open Journal of Gastroenterology, 3, 231-236. doi: 10.4236/ojgas.2013.34039.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Everhart, J.E., Kruszon-Moran, D., Perez-Perez, G.I., Tralka, T.S. and McQuillan, G. (2000) Seroprevalence and ethnic differences in Helicobacter pylori infection among adults in the United States. The Journal of Infectious Diseases, 181, 1359-1363. doi:10.1086/315384
[2] US Census Bureau (2012) Resident population by hispanic origin and state: 2010.
[3] Cardenas, V.M., Mena, K.D., Ortiz, M., et al. (2010) Hyperendemic H. pylori and tapeworm infections in a U.S.Mexico border population. Public Health Reports, 125, 441-447.
[4] Tsai, C.J., Perry, S., Sanchez, L. and Parsonnet, J. (2005) Helicobacter pylori infection in different generations of Hispanics in the San Francisco Bay Area. American Journal of Epidemiology, 162, 351-357. doi:10.1093/aje/kwi207
[5] Sethi, A., Chaudhuri, M., Kelly, L. and Hopman, W. (2013) Prevalence of Helicobacter pylori in a first nations population in northwestern Ontario. Canadian Family Physician, 59, e182-e187.
[6] Jones, N., Chiba, N., Fallone, C., et al. (2012) Helicobacter pylori in first nations and recent immigrant populations in Canada. Canadian Journal of Gastroenterology, 26, 97-103.
[7] Grad, Y.H., Lipsitch, M. and Aiello, A.E. (2012) Secular trends in Helicobacter pylori seroprevalence in adults in the United States: Evidence for sustained race/ethnic disparities. American Journal of Epidemiology, 175, 54-59. doi:10.1093/aje/kwr288
[8] Leclerc, H. (2006) Epidemiological aspects of Helicobacter pylori infection. Bulletin de l’Academie Nationale de Medecine, 190, 949-962.
[9] Brown, L.M. (2000) Helicobacter pylori: Epidemiology and routes of transmission. Epidemiologic Reviews, 22, 283-297. doi:10.1093/oxfordjournals.epirev.a018040
[10] Pew Hispanic Center (2010) Statistical portrait of the foreign-born population in the United States.
[11] US Census Bureau (2010) Hispanics or latino population for the United States, region, states, and for Puerto Rico.
[12] DeNavas-Walt, C., Proctor, B.D. and Smith, J.C. (2012) Income, poverty, and health insurance coverage in the United States: 2011. US Census Bureau, Current Population Reports, P60-243, US Government Printing Office, Washington DC.
[13] US Census Bureau (2011) Uninsured rate by real household income: 1999 to 2011.
[14] (2010) Statistical portrait of the foreign-born population in the United States Pew Hispanic Center.
[15] Uemura, N., Okamoto, S., Yamamoto, S., et al. (2001) Helicobacter pylori infection and the development of gastric cancer. The New England Journal of Medicine, 345, 784-789. doi:10.1056/NEJMoa001999
[16] Kuipers, E.J., Uyterlinde, A.M., Pena, A.S., et al. (1995) Long-term sequelae of Helicobacter pylori gastritis. Lancet, 345, 1525-1528. doi:10.1016/S0140-6736(95)91084-0
[17] Brenner, H., Bode, G., Adler, G., Hoffmeister, A., Koenig, W. and Rothenbacher, D. (2001) Alcohol as a gastric disinfectant? The complex relationship between alcohol consumption and current Helicobacter pylori infection. Epidemiology, 12, 209-214. doi:10.1097/00001648-200103000-00013
[18] Zhang, L., Eslick, G.D., Xia, H.H., Wu, C., Phung, N. and Talley, N.J. (2010) Relationship between alcohol consumption and active Helicobacter pylori infection. Alcohol and Alcoholism, 45, 89-94. doi:10.1093/alcalc/agp068
[19] Hishida, A., Matsuo, K., Goto, Y., et al. (2010) Smoking behavior and risk of Helicobacter pylori infection, gastric atrophy and gastric cancer in Japanese. Asian Pacific Journal of Cancer Prevention, 11, 669-673.
[20] Konturek, S.J., Bielanski, W., Plonka, M., et al. (2003) Helicobacter pylori, non-steroidal anti-inflammatory drugs and smoking in risk pattern of gastroduodenal ulcers. Scandinavian Journal of Gastroenterology, 38, 923-930. doi:10.1080/00365520310004696

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.