The Prevalence of Helicobacter pylori Remains High in African American and Hispanic Veterans Theresa Nguyen,* ,† David Ramsey,* David Graham, ‡,§ Yasser Shaib, § Seiji Shiota, §,‡ Maria Velez, §,‡ Rhonda Cole, §,‡ Bhupinderjit Anand, §,‡ Marcelo Vela §,‡ and Hashem B. El-Serag* ,‡,§ *Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA, † Department of Medicine, Baylor College of Medicine, Houston, Texas, USA, ‡ Section of Gastro enterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA, § Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA Keywords Helicobacter pylori, race, birth cohort, socioeconomic status, age group. Reprint requests to: Hashem B. El-Serag, MEDVAMC 152, 2002 Holcombe Blvd., Houston, TX 77030, USA. E-mail: hasheme@bcm.edu Abstract Background: Helicobacter pylori in the United States has been declining in the 1990s albeit less so among blacks and Hispanics. As the socioeconomic status of racial groups has evolved, it remains unclear whether the prevalence or the racial and ethnic disparities in the prevalence of H. pylori have changed. Methods: This is a cross-sectional study from a Veteran Affairs center among patients aged 40–80 years old who underwent a study esophagogastroduode- noscopy with gastric biopsies, which were cultured for H. pylori irrespective of findings on histopathology. Positive H. pylori was defined as positive cul- ture or histopathology (stained organism combined with active gastritis). We calculated age-, race-, and birth cohort-specific H. pylori prevalence rates and examined predictors of H. pylori infection in logistic regression models. Results: We analyzed data on 1200 patients; most (92.8%) were men and non-Hispanic white (59.9%) or black (28.9%). H. pylori was positive in 347 (28.9%) and was highest among black males aged 50–59 (53.3%; 44.0– 62.4%), followed by Hispanic males aged 60–69 (48.1%; 34.2–62.2%), and lowest in non-Hispanic white males aged 40–49 (8.2%; 2.7–20.5%). In mul- tivariate analysis, age group 50–59 was significantly associated with H. pylori (adjusted odds ratio (OR), 2.32; 95% confidence interval (CI), 1.21–4.45) compared with those aged 40–49, and with black race (adjusted OR, 2.57; 95% CI, 1.83–3.60) and Hispanic ethnicity (adjusted OR, 3.01; 95% CI, 1.70–5.34) compared with non-Hispanic white. Irrespective of age group, patients born during 1960–1969 had a lower risk of H. pylori (adjusted OR, 0.45; 95% CI, 0.22–0.96) compared to those born in 1930–1939. Those with some college education were less likely to have H. pylori compared to those with no college education (adjusted OR 0.51; 95% CI, 0.37–0.69). Conclusion: Among veterans, the prevalence of active H. pylori remains high (28.9%) with even higher rates in blacks and Hispanics with lower education levels. Study Highlights 1. What is Current Knowledge? a. The seroprevalence of Helicobacter pylori has been declining in the United States in the 1990s. b. There have been no large studies examining the prevalence of active H. pylori infection in the Uni- ted States since 1999–2000. 2. What is New Here? a. The prevalence of active H. pylori infection in the United States remains high (28.9%). b. Racial and socioeconomic disparities in H. pylori infection still exist, as prevalence rates are even higher in blacks and Hispanics with lower educa- tion levels. Helicobacter pylori (H. pylori) infection affects 50–60% of the world population [1,2] with marked geographic variation [3]. H. pylori prevalence in developing © 2015 John Wiley & Sons Ltd, Helicobacter 20: 305–315 305 Helicobacter ISSN 1523-5378 doi: 10.1111/hel.12199