

@article {13895,
	title = {Environmental risk factors associated with {Helicobacter} pylori seroprevalence in the {United} {States}: a cross-sectional analysis of {NHANES} data.},
	journal = {Epidemiology and infection},
	volume = {143},
	number = {12},
	year = {2015},
	month = {sep},
	pages = {2520{\textendash}31},
	abstract = {Helicobacter pylori imparts a considerable burden to public health. Infections are mainly acquired in childhood and can lead to chronic diseases, including gastric ulcers and cancer. The bacterium subsists in water, but the environment{\textquoteright}s role in transmission remains poorly understood. The nationally representative National Health and Nutrition Examination Survey (NHANES) was examined for environmental risk factors associated with H. pylori seroprevalence. Data from 1999-2000 were examined and weighted to represent the US population. Multivariable logistic regression estimated adjusted odds ratios (aOR) and 95\% confidence intervals (CI) for associations with seropositivity. Self-reported general health condition was inversely associated with seropositivity. Of participants aged {\textbackslash}textless20 years, seropositivity was significantly associated with having a well as the source of home tap water (aOR 1{\textperiodcentered}7, 95\% CI 1{\textperiodcentered}1-2{\textperiodcentered}6) and living in a more crowded home (aOR 2{\textperiodcentered}3, 95\% CI 1{\textperiodcentered}5-3{\textperiodcentered}7). Of adults aged ⩾20 years, seropositivity was not associated with well water or crowded living conditions, but adults in soil-related occupations had significantly higher odds of seropositivity compared to those in non-soil-related occupations (aOR 1{\textperiodcentered}9, 95\% CI 1{\textperiodcentered}2-2{\textperiodcentered}9). Exposures to both well water and occupationally related soil increased the effect size of adults{\textquoteright} odds of seropositivity compared to non-exposed adults (aOR 2{\textperiodcentered}7, 95\% CI 1{\textperiodcentered}3-5{\textperiodcentered}6). Environmental exposures (well-water usage and occupational contact with soil) play a role in H. pylori transmission. A disproportionate burden of infection is associated with poor health and crowded living conditions, but risks vary by age and race/ethnicity. These findings could help inform interventions to reduce the burden of infections in the United States.},
	keywords = {Adolescent, Adult, Age Factors, Child, Cross-Sectional Studies, Female, Health Status, Helicobacter Infections, Helicobacter Infections: epidemiology, Helicobacter Infections: ethnology, helicobacter pylori, Humans, Male, Middle Aged, Nutrition Surveys, Occupations, Occupations: statistics \& numerical data, Preschool, Seroepidemiologic Studies, Socioeconomic Factors, Soil Microbiology, United States, United States: epidemiology, Water Wells, Water Wells: microbiology, Young Adult},
	issn = {1469-4409},
	doi = {10.1017/S0950268814003938},
	url = {http://journals.cambridge.org/abstract_S0950268814003938},
	author = {Krueger, W S and Hilborn, E D and Converse, R R and Wade, T J}
}
