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Original Investigation
July 10, 2000

Impact of Helicobacter pylori Infection on Gastric Cancer Incidence in a General Japanese Population: The Hisayama Study

Author Affiliations

From the Second Department of Internal Medicine, Faculty of Medicine, Kyushu University (Drs Yamagata, Kiyohara, Kato, Iwamoto, Nakayama, Shimizu, Tanizaki, Arima, Shinohara, Kondo, Matsumoto, and Fujishima), and the First Department of Internal Medicine, Faculty of Medicine, Fukuoka University (Dr Aoyagi), Fukuoka City, Japan.

Arch Intern Med. 2000;160(13):1962-1968. doi:10.1001/archinte.160.13.1962

Background  Several nested case-control studies have reported the potentially causal relationship between Helicobacter pylori infection and the development of gastric cancer. However, there has been no prospective study evaluating this issue. The purpose of this study is to examine the impact of H pylori infection on gastric cancer occurrence in a general Japanese population (Hisayama, Japan) stratified according to sex, using a prospective study design.

Methods  A total of 2602 subjects aged 40 years or older (1070 men; mean age, 57 years; 1532 women; mean age, 59 years) without a history of gastrectomy or gastric cancer were classified according to the status of the serum IgG antibodies to H pylori and observed prospectively for 9 years from 1988.

Results  Infection of H pylori was more common in men (71.5%) than in women (62.5%; P<.001). The age-adjusted incidence of gastric cancer for men (5.3 per 1000 person-years) was 4-fold higher than that for women (1.3; P<.001). In men, the age-adjusted incidence of gastric cancer was significantly higher in the subjects with H pylori infection than in those without it (6.2 vs 2.5; relative risk, 2.59 [95% confidence interval, 1.03-6.50]), whereas no significant difference was observed in women (1.2 vs 1.1; relative risk, 0.99 [95% confidence interval, 0.36-2.68]). These results were similar even after controlling for other risk factors in multivariate analysis. It was estimated that 40.1% of gastric cancers for men in this cohort were attributable to H pylori infection.

Conclusion  A significant relationship exists between infection with H pylori and subsequent occurrence of gastric cancer for men but not for women in this Japanese population.