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American Journal of Epidemiology Advance Access originally published online on October 22, 2008
American Journal of Epidemiology 2008 168(12):1409-1415; doi:10.1093/aje/kwn276
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Population-based Prospective Study of the Combined Influence of Cigarette Smoking and Helicobacter pylori Infection on Gastric Cancer Incidence

The Hisayama Study

Kentaro Shikata, Yasufumi Doi, Koji Yonemoto, Hisatomi Arima, Toshiharu Ninomiya, Michiaki Kubo, Yumihiro Tanizaki, Takayuki Matsumoto, Mitsuo Iida and Yutaka Kiyohara

Correspondence to Dr. Yutaka Kiyohara, Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City 812-8525, Japan (e-mail: kiyohara{at}envmed.med.kyushu-u.ac.jp).

Received for publication October 2, 2007. Accepted for publication August 1, 2008.

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 ≥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 ≥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.

cohort studies; Helicobacter pylori; smoking; stomach neoplasms

Abbreviations: CI, confidence interval; HR, hazard ratio; PAF, population attributable fraction


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