Social determinants of health and Helicobacter pylori infection prevalence: a systematic review and meta-analysis.

2026-01-13
Frontiers in public health 13
- Hengmin Wang
- Zhenyu Wang
- JianGen Yu
- Jianan Jin

PubMed: 41607896
DOI: 10.3389/fpubh.2025.1703158

Study Design

Type: Meta-Analysis
Sample size: n = 956
Population: 57 studies (n = 387,956 participants)
Methods: Systematic search of PubMed, EMBASE, and Web of Science from inception to July 2025; included observational studies; standardized SDoH into binary categories; pooled prevalence and cORs using random-effects models (Hartung-Knapp method with Paule-Mandel τ² estimator); Haldane-Anscombe correction; pre-specified subgroup and exploratory meta-regression; publication bias assessment

Objective

Helicobacter pylori infection represents a major public health challenge. While its transmission risk is potentially influenced by social determinants of health (SDoH), existing evidence remains fragmented. This study aimed to systematically evaluate the associations between various SDoH and Helicobacter pylori infection risk under a unified mapping framework and to explore the major sources of heterogeneity.

Methods

We systematically searched PubMed, EMBASE, and Web of Science from inception to July 2025. Observational studies in human populations were included. SDoH were standardized into binary categories based on pre-defined rules. The prevalence of Helicobacter pylori and crude odds ratios (cORs) were pooled separately using random-effects models (Hartung-Knapp method with Paule-Mandel τ² estimator). The Haldane-Anscombe correction was applied for zero cells. Pre-specified subgroup and exploratory meta-regression analyses were performed, and publication bias was assessed.

Results

A total of 57 studies (n = 387,956 participants) were included. The overall pooled prevalence of Helicobacter pylori infection was 43% (95% CI: 36-50%), with considerable between-study heterogeneity (I² = 99.6%). Subgroup analysis revealed significant variation across diagnostic methods (stool antigen test: 52%; urea breath test: 46%). In the analysis of SDoH associations, most adverse SDoH were positively associated with Helicobacter pylori infection. Household overcrowding (OR = 1.38, 95% CI: 1.03-1.85) and occupational instability (OR = 1.23, 95% CI: 1.05-1.45) showed statistically significant associations. Although the main analysis for education level was non-significant, a clear gradient was evident: the effect size for low versus high education (OR = 3.49) was stronger than that for low versus medium education (OR = 1.60). Meta-regression identified geographical region as the only stable source of heterogeneity.

Conclusion

SDoH exert a significant influence on Helicobacter pylori infection risk, with household overcrowding, the educational gradient, and occupational instability being the most critical factors. In high-burden regions, public health strategies should prioritize alleviating housing overcrowding, enhancing education, and providing employment support to optimize primary prevention and screening strategies for Helicobacter pylori.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251102412, CRD420251102412.