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Eur J Cancer Prev. 2019 Sep;28(5):390-396. doi: 10.1097/CEJ.0000000000000471.

Smoking and Helicobacter pylori infection: an individual participant pooled analysis (Stomach Cancer Pooling- StoP Project).

Author information

EPIUnit - Instituto de Saúde Pública.
Department of Clinical Sciences and Community Health.
Department of Health of Madrid, Epidemiology Section, Public Health Division.
CIBER Epidemiología y Salud Pública, Madrid, Spain.
ISGlobal, Centre for Research in Environmental Epidemiology.
IMIM (Hospital del Mar Medical Research Institute).
Universitat Pompeu Fabra, Barcelona, Spain.
Mexico National Institute of Public Health, Morelos.
Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran.
Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
Nikkei Disease Prevention Center, São Paulo, Brazil.
Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, USA.
Dirección General de Planeación y Desarrollo en Salud, Ciudad de México, Mexico.
Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia.
Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA.
Medical Informatics Center, Peking University, Peking, China.
Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
Nutritional Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga.
Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.
Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.


Smoking has been associated with acquisition and increased persistence of Helicobacter pylori infection, as well as with lower effectiveness of its eradication. A greater prevalence of infection among smokers could contribute to the increased risk for gastric cancer. We aimed to estimate the association between smoking and seropositivity to H. pylori through an individual participant data pooled analysis using controls from 14 case-control studies participating in the Stomach Cancer Pooling Project. Summary odds ratios and prevalence ratios (PRs), adjusted for age, sex and social class, and the corresponding 95% confidence intervals (CIs) were estimated through random-effects meta-analysis. Heterogeneity was quantified using the I statistic and publication bias with Egger's test. There was no significant association between smoking (ever vs. never) and H. pylori seropositivity (adjusted odds ratio = 1.08; 95% CI: 0.89-1.32; adjusted PR = 1.01; 95% CI: 0.98-1.05). The strength of the association did not increase with the intensity or duration of smoking; stratified analyses according to sex, age, region or type of sample did not yield a consistent pattern of variation or statistically significant results, except for participants younger than 55 years and who had been smoking for more than 30 years (adjusted PR = 1.08; 95% CI: 1.02-1.15). This is the first collaborative analysis providing pooled estimates for the association between smoking and H. pylori seropositivity, based on detailed and uniform information and adjusting for major covariates. The results do not support an association between smoking and H. pylori infection.

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