Planning mass eradication of Helicobacter pylori infection for indigenous Taiwanese peoples to reduce gastric cancer

Abstract

Background and Aim The aim of this study is to identify gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in Indigenous communities. Methods First, we quantified the health disparities in gastric cancer in Indigenous peoples using data from the cancer registries during the period of 2006–2014. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy. Results Gastric cancer incidence (24.4 vs 12.3 per 100 000 person‐years) and mortality rates (15.8 vs 6.8 per 100 000 person‐years) were higher in Indigenous than in non‐Indigenous, with 2.19‐fold (95% confidence interval [CI]: 2.06–2.33) and 2.47‐fold (2.28–2.67) increased risk, respectively. In Indigenous communities, H. pylori infection was more prevalent in Indigenous than in non‐Indigenous (59.4% vs 31.5%, P < 0.01). Regression analyses consistently showed that either the mountain or plain Indigenous had 1.89‐fold (95% CI: 1.34–2.66) and 1.73‐fold (95% CI: 1.24–2.41) increased risk for H. pylori infection, respectively, as compared with non‐Indigenous, adjusting for other baseline characteristics. The high infection rates were similarly seen in young, middle‐aged, and older adults. Program eradication rates using clarithromycin‐based triple therapy were suboptimal (73.7%, 95% CI: 70.0–77.4%); the habits of smoking (1.70‐fold, 95% CI: 1.01–2.39) and betel nut chewing (1.54‐fold, 95% CI: 0.93–2.16) were associated with the higher risk of treatment failure. Conclusion Gastric cancer burden is higher in Indigenous Taiwanese peoples than in their non‐Indigenous counterparts. Eliminating the prevalent risk factor of H. pylori infection is a top priority to reduce this health disparity.

Native and Indigenous Populations and Gastric Cancer: A Worldwide Review

“…Indigenous people are more likely to be infected with H. pylori, elevating risk for gastric cancer [3]. In Taiwan, Indigenous populations have a 27.9% higher prevalence of H. pylori than non-Indigenous [4]. Similar findings have been found in Maori of New Zealand, with Maori children having 14% higher prevalence of H. pylori infection and adults having a 21% higher prevalence than non-Maori [38].…”

“…Reinfection has also been found to occur among Alaska Natives after treatment [7,44]. Smoking has also been found to decrease antibiotic treatment efficacy of H. pylori among the Indigenous population of Taiwan [4].…”

“…Although gastric cancer has decreased globally over the last several decades, incidence and mortality rates remain elevated for Indigenous people [3]. In Taiwan, the Indigenous population has nearly twice the incidence and more than double the mortality rate compared to their non-Indigenous counterparts [4]. In New Zealand, the Indigenous Maori population has experienced an increased incidence and higher mortality rate for gastric cancer compared to non-Maori [5].…”

Mass eradication ofHelicobacter pylorito reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands

“…Even though the number of participants in our study population was relatively small, targeting high-risk subpopulations is more applicable and generalisable as a healthcare policy than a wide treatment of the population as a whole. 41 However, our study has limitations. The major limitation is that it was not a randomised controlled trial that generated groups with comparable baseline profiles to validate the effects of the eradication treatment; ethical considerations in this high-risk area precluded the use of such a study design.…”

Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus

“…In intermediaterisk populations, other diseases are more likely to compete for the limited resources, so the policy making should consider more how to optimise the resources-for example, incorporation of the screening service within the existing healthcare framework can substantially reduce the cost. 70 Even in low-risk populations, such an approach is still applicable as there are probably some high-risk ethnicities or immigrants from high-risk areas, 71 for whom, active screening can reduce the cancer risk and also reduce the risk of H. pylori transmission in the community. 72…”