Population-based prospective study of the combined influence of cigarette smoking and Helicobacter pylori infection on gastric cancer incidence: the Hisayama Study

Am J Epidemiol. 2008 Dec 15;168(12):1409-15. doi: 10.1093/aje/kwn276. Epub 2008 Oct 22.

Abstract

The authors assessed the separate and joint influences of cigarette smoking and Helicobacter pylori infection on the development of gastric cancer in a population-based prospective study. A total of 1,071 Japanese men aged > or =40 years were followed up prospectively for 14 years (1998-2002). Compared with that for current nonsmokers, the multivariate-adjusted hazard ratios of gastric cancer for smokers of 1-9, 10-19, and > or =20 cigarettes per day were 1.36 (95% confidence interval (CI): 0.50, 3.71), 1.93 (95% CI: 1.01, 3.67), and 1.88 (95% CI: 1.02, 3.43), respectively. The risk of gastric cancer increased steeply for subjects who had both a smoking habit and H. pylori infection compared with those who did not have both risk factors (hazard ratio = 11.41, 95% CI: 1.54, 84.67). If causal, the estimated population attributable fraction of gastric cancer for cigarette smoking was approximately half that for H. pylori infection (28.4% vs. 56.2%). The overlap of the population attributable fractions for the 2 factors was 49.6%. Findings suggest that cigarette smoking and H. pylori infection are significant risk factors for gastric cancer in Japanese men, and the magnitude of their combined influence is considerable.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • Helicobacter Infections / complications*
  • Helicobacter Infections / epidemiology
  • Humans
  • Incidence
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Population Surveillance*
  • Prospective Studies
  • Risk Factors
  • Rural Population*
  • Smoking / adverse effects*
  • Stomach Neoplasms / epidemiology*
  • Stomach Neoplasms / etiology