Abstract：
Environmental waters (EW) substantially lend to the transmission of Helicobacter pylori (Hp). But the increase in Hp infections and antimicrobial resistance is often attributed to socioeconomic status. The connection between socioeconomic status and Hp prevalence in EW is however yet to be investigated. This study aimed to assess the impacts of socioeconomic indices (SI: continent, world bank region (WBR), world bank income (WBI), WHO region, Socio-demographic Index (SDI quintile), Sustainable Development Index (SuDI), and Human Development Index (HDI)) on the prevalence of Hp in EW. Hp-EW data were fitted to a generalized linear mixed-effects model and SI-guided meta-regression models with a 1000-resampling test. The worldwide prevalence of Hp in EW was 21.76% [95% confidence interval [CI]: 10.29-40.29], which declined significantly from 59.52% [43.28-74.37] in 1990-99 to 19.36% [3.99-58.09] in 2010-19 and with increasing trend in 2020-22 (33.33%, 22.66-45.43). Hp prevalence in EW was highest in North America (45.12%, 17.07-76.66), then Europe (22.38%, 5.96-56.74), South America (22.09%, 13.76-33.49), Asia (2.98%, 0.02-85.17), and Africa (2.56%, 0.00-99.99). It was negligibly different among sampling settings, WBI, and WHO regions demonstrating highest prevalence in rural location [42.62%, 3.07-94.56], HIEs [32.82%, 13.19-61.10], and AMR [39.43%, 19.92-63.01], respectively. However, HDI, sample size, and microbiological method robustly predict Hp prevalence in EW justifying 26.08%, 21.15%, and 16.44% of the true difference, respectively. In conclusion, Hp is highly prevalence in EW across regional/socioeconomic strata and thus challenged the uses of socioeconomic status as surrogate for hygienic/sanitary practices in estimating Hp infection prevalence.
摘要：
环境水（EW）基本上有助于幽门螺杆菌（Hp）的传播。但是Hp感染和抗菌素耐药性的增加通常归因于社会经济地位。然而，EW中社会经济地位与Hp患病率之间的联系尚待研究。本研究旨在评估社会经济指数(SI：大陆，世界银行地区(WBR)，世界银行收入(WBI)，世卫组织区域，社会人口指数(SDI五分位数)，可持续发展指数（SuDI），和人类发展指数（HDI））关于高血压在EW中的患病率。将Hp-EW数据拟合到具有1000重抽样检验的广义线性混合效应模型和SI指导的元回归模型。Hp在EW中的全球患病率为21.76％[95％置信区间[CI]：10.29-40.29]，从1990-99年的59.52%[43.28-74.37]大幅下降至2010-19年的19.36%[3.99-58.09]，并在2020-22年呈上升趋势（33.33%，22.66-45.43)。EW中的Hp患病率在北美最高(45.12%，17.07-76.66),然后是欧洲(22.38%，5.96-56.74),南美洲（22.09%，13.76-33.49),亚洲（2.98%，0.02-85.17),和非洲(2.56%，0.00-99.99)。采样设置之间的差异可以忽略不计，WBI,世卫组织农村地区患病率最高[42.62%，3.07-94.56],HIE[32.82%，13.19-61.10],和AMR[39.43%，19.92-63.01]，分别。然而,HDI,样本量,微生物学方法有力地预测了EW中Hp的患病率，证明为26.08%，21.15%,和真正差异的16.44%，分别。总之,Hp在区域/社会经济阶层的EW中高度流行，因此挑战了将社会经济地位用作估计Hp感染流行率的卫生/卫生习惯的替代方法。
