Infection Characteristics and Transmission Patterns of Helicobacter pylori in Families of Early Gastric Cancer Patients

Infection Characteristics and Transmission Patterns of Helicobacter pylori in Families of Early Gastric Cancer Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Infection Characteristics and Transmission Patterns of Helicobacter pylori in Families of Early Gastric Cancer Patients Shangtao Mao, Tao Zhao, Jingrou Sun, Miao Liu, Hai Wu, Ying Xiang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6897943/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background : The prevention and control strategies for Helicobacter pylori (H. pylori) are gradually shifting from individual-based care to family-based management approaches. However, the infection status, risk factors, and transmission dynamics of H. pylori within families of early gastric cancer (EGC) patients remain to be elucidated. Methods : This family-based study was conducted at Nanjing Drum Tower Hospital from June to December 2024, targeting cohabiting fam1ily members of EGC patients. Inclusion criteria required family members to have lived together for at least 10 months per year, with a minimum of two members and no upper limit on household size. An infected household was defined as having at least one member testing positive for H. pylori. The study investigated household H. pylori infection status, associated risk factors, and transmission patterns. Results : Among the 125 enrolled households, 21 (16.8%) consisted of 2 members, 57 (45.6%) of 3 members, 36 (28.8%) of 4 members, 5 (4.0%) of 5 members, 5 (4.0%) of 6 members, and 1 (0.8%) of 7 members. Of these households, 4 households (3.2%) showed no infections, 84 households (67.2%) had partial infections, and 37 households (29.6%) had full-family infections. Among the households, 79 (55.8%) included one couple, 34 (27.2%) included two couples, and 2 (1.6%) included three couples, while 10 households (8.0%) included only a husband or wife. In 153 couples, 67 couples (43.8%) had both partners infected, 22 couples (14.4%) had neither partner infected, and in the remaining couples, only one partner was infected. At the household level, higher annual household income was associated with a lower risk of infection (OR = 0.26, 95% CI: 0.08–0.80, p = 0.019). At the individual level, older age, occupations such as farming or freelancing, exposure to infected household members, and a history of gastrointestinal discomfort were significant risk factors for infection (p < 0.05). At the spousal level, infection rates increased with the duration of cohabitation (p < 0.05). Conclusion : The infection rate in families of EGC patients was higher than in the general population, and EGC patients are likely the primary source of transmission within these households. Monitoring and eradicating Helicobacter pylori infection in family members of patients with early gastric cancer is very important for preventing and controlling the occurrence of gastric cancer. Helicobacter pylori Early gastric cancer Infection patterns Transmission Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Gastric cancer is the third leading cause of cancer death worldwide, contributing to about 8% of cancer-related deaths [ 1 ]. The development of many cases of gastric cancer are related to Helicobacter pylori infection. Chronic Helicobacter pylori infection leads to a sequence of events, including chronic atrophic gastritis and gastric cancer [ 2 ]. Approximately 4.4 billion people worldwide are infected with H. pylori, with significant regional variations in infection rates [ 3 ]. In China, the primary transmission routes is intra-familial transmission and the risk of H. pylori infection is higher with the number of infected members [ 4 – 6 ]. In particular, infected parents, especially mothers, who are central to child-rearing, play a critical role in facilitating intra-familial transmission [ 7 – 11 ]. The infection rate in Chinese residents is approximately 44.2%, with the prevalence increasing with age, from 28.0% in children and adolescents to 46.1% in adults [ 12 ]. The annual incidence of gastric cancer in China is 20.2 per 100,000 people, and the mortality rate is 14.7 per 100,000, respectively [ 1 ]. H. pylori infection remains a major cause of gastric cancer in China, accounting for 40.7% of cardia gastric cancer and 62.1% of non-cardia gastric cancer cases [ 13 ]. Stratified analyses indicate that intra-familial transmission is a key mode of H. pylori infection in China [ 6 ]. Large-scale clinical studies and international consensus reports recommend screening and eradicating H. pylori in populations from high-infection regions as a preventive measure for gastric cancer [ 14 – 18 ]. Currently, the approach to H. pylori control is shifting from individual prevention and treatment strategies to family-based infection control strategies [ 19 – 20 ]. In 2021, China introduced the "Chinese Consensus Report on Family-Based Helicobacter pylori Infection Control and Management "[ 21 ]. This consensus advocates for a family-centered approach to controlling H. pylori infection. Despite increasing attention to the issue of familial H. pylori infection with the advancement of clinical practice and understanding, no studies have yet focused on investigating H. pylori infection within the families of early gastric cancer patients. Since China is one of the regions where both H. pylori infection and gastric cancer are highly prevalent, it is very important to elucidate the infection patterns of Helicobacter pylori within families of early gastric cancer for the control of the early gastric cancer. This study will conduct a questionnaire survey targeting the families of early gastric cancer patients to explore the infection status, risk factors, and transmission routes within these households. Such investigations will provide critical evidence for addressing high-risk family infections, contributing to the development of eradication strategies for infection control and disease prevention centered around gastric cancer patients. Ultimately, this will help reduce the risk of gastric cancer. Methods Study Design and Participant enrollment This family-based survey was conducted from June to December 2024 at Nanjing Drum Tower Hospital. Participants were family members cohabiting with gastric early cancer patients who visited the outpatient clinic, were re-examined, or were admitted for treatment. Families with two or more members were invited to participate in the survey. A family could consist of a couple, with or without children, multiple generations of couples, or single parents with children, without a limit on the maximum number of family members living together. To ensure the accuracy of the 13C urea breath test and avoid false-negative results, the following exclusion criteria were applied: (1) Family members who had used antibiotics within the past month, (2) Family members who had used proton pump inhibitors within the past two weeks, (3) Family members who had previously undergone treatment for H. pylori within the past three months, (4) Individuals with severe heart, liver, or kidney dysfunction, and (5) those with contraindications for H. pylori testing. However, family members who had successfully eradicated H. pylori more than three months ago were eligible for inclusion. This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Nanjing Drum Tower Hospital (IRB No. 2025-0075-01). Helicobacter pylori Testing for Family Members Family members participating in the survey who had previously undergone Helicobacter pylori testing were required to upload their test reports or documentation to an app for centralized collection, review, verification, and management. Family members who had not undergone Helicobacter pylori testing were required to undergo the 13 C urea breath test at the outpatient clinic and subsequently upload their test reports. We ensured that every participating family member completed the necessary Helicobacter pylori testing. Definitions Infected households are defined as those with at least one infected member, whereas uninfected households are those where all members tested negative for H. pylori . Partial infection refers to a family in which at least one member is not infected with H. pylori . Complete infection is defined as a family in which all members are infected with H. pylori . In the stratified analysis of couples, single partner infection refers to couples where only one partner is infected with Helicobacter pylori. Family Member Questionnaire Survey Participation in the survey was voluntary for gastric early cancer patients, with no special rewards offered. The survey questionnaire is designed with reference to the 2023 study by Xian-Zhu Zhou [ 6 ].All family members of the patients were required to participate. Trained doctors assisted on-site with the registration process and survey completion (Supplementary File 1). For each eligible family, members were asked to complete a questionnaire. The head of the household was responsible for providing information about the family, including the number of family members, annual income, living area, household hygiene, and conditions related to animal rearing. Data auditors verified and calibrated the information provided. All data were kept confidential and were used solely for analysis. Statistical analysis Continuous variables are presented as medians and interquartile ranges (IQR) or as mean ± standard deviation (SD) and analyzed using t-tests or Mann-Whitney U tests, as appropriate. Categorical variables are reported as frequencies (percentages) and compared using Pearson's chi-square test or Fisher's exact test. All variables on univariate analysis with p < 0.05 were included in the multivariate logistic regression analysis. Statistical analyses were conducted using SPSS version 26.0 and R version 4.2.3, with a p-value < 0.05 (two-sided) considered statistically significant. Results General Characteristics of Included Families and Individual Members Flow chart of family enrollment information is shown in Fig. 1. A total of 176 families completed the questionnaire survey, among which 125 families were included in the study after screening. The analysis encompassed 421 members from these families. The mean age of the study population was 52.9 years, with 203 males (48.2%) and 218 females (51.8%). There were 254 cases of H. pylori infection, and the overall individual infection rate for H. pylori was 60.33%. The average household size among the 125 enrolled families was 3.35 members. Of these, 121 (96.8%) families had at least one infected member.A significant association was observed between age and H. pylori infection across different age groups, with the infection rate increasing with age among adults (Fig. 2). In families with early gastric cancer, the H. pylori infection rate increases rapidly in individuals over the age of 40. Household H. pylori Infection Status and Risk Factors Among the 125 families included in the study, the distribution of household sizes was as follows: 21 two-member households (16.8%), 57 three-member households (45.6%), 36 four-member households (28.8%), 5 five-member households (4.0%), 5 six-member households (4.0%), and 1 seven-member household (0.8%). Of these households, 3.2% had no infected members, while 14.0% had all members infected. Partial infection among household members was observed in 84 households (67.2%), and complete infection was observed in 37 households (29.6%). Table 1 presents the infection rates and risk factor analysis for households with partial and complete infection. Higher household income was associated with a lower risk of infection. After adjustment, households with an annual income of 100,000–300,000 CNY had a significantly lower infection risk (adjusted OR = 0.26, 95% CI: 0.08–0.80, p = 0.019). Although households with an income exceeding 300,000 CNY also showed a trend toward reduced risk, the association did not reach statistical significance (adjusted OR = 0.27, 95% CI: 0.05–1.49, p = 0.134). Stratified analysis revealed that low-income households had higher complete infection rates, whereas the reverse was true for high-income households (Fig. 2A). Interestingly, household size was inversely associated with the risk of complete household infection, which appears counterintuitive. (with an all-members infection rate of 66.67% in two-member households) (Fig. 2B). Other factors, such as place of residence, household living area, source of drinking water, methods of tableware cleaning and disinfection, sharing of utensils, and the use of communal chopsticks, did not show a significant association with infection risk ( p > 0.05), which may be attributed to the limited sample size. Individual-based H.pylori infection status and risk factors The individual-level infection status and associated risk factors are presented in Table 2. Older age, occupations such as farming and freelancing, exposure to infected household members, and a history of gastrointestinal discomfort were associated with a significantly higher risk of infection (p < 0.05). In multivariable logistic regression analysis, age emerged as a significant independent risk factor, with infection risk increasing with advancing age (Adjusted OR = 1.05, p < 0.001). Infection was strongly associated with the presence of infected household members (e.g., households with five infected members: OR = 46.11, 95% CI: 4.16–510.83, p = 0.002). Additionally, farming (OR = 3.36, 95% CI: 1.23–9.19, p = 0.018), freelancing (OR = 2.05, 95% CI: 1.03–4.09, p = 0.040), and a history of gastrointestinal discomfort (OR = 4.85, 95% CI: 2.68–8.77, p < 0.001) were identified as independent risk factors for H. pylori infection. H. pylori Infection Status and Risk Factors Among Couples To further investigate the risk factors and transmission patterns among couples, we analyzed the infection status within this population. Among the 125 families, 79 families (55.8%) included one couple, 34 families (27.2%) included two couples, and 2 families (1.6%) included three couples (Fig. 3A). Additionally, 10 families (8.0%) consisted of only a husband or wife. Among the 153 couples, 67 couples (43.8%) were both infected with H. pylori, while 22 couples (14.4%) were both uninfected. The remaining couples had one partner infected (Fig. 3B). In cases where one spouse is infected, infection in the husband is more commonly observed. The infection rate increased with the duration of cohabitation (p < 0.05), with couples who had cohabited for shorter durations exhibiting lower infection rates, whereas those with longer cohabitation durations exhibited higher rates (Fig. 3C). Couples who had cohabited for shorter durations (0–5 years) exhibited the lowest infection rates, with only 3.0% of couples both infected, 6.7% with a single infected partner, and 18.2% with no infection. In contrast, couples who have cohabited for > 30 years showed a significantly higher infection rate, 80.9% have both partners infected, 58.9% have one partner infected, and 4.5% have no infection. Furthermore, a general trend of decreasing H. pylori infection rates with increasing household income was observed (Fig. 3D). Couples with an annual household income 300 thousand yuan showed a lower infection rate of 10.4% of couples both infected. H. pylori Infection Status in Offspring To investigate the infection status of H. pylori in offspring and its relationship with parental infection status, we further analyzed the infection rates of offspring and potential intrafamilial transmission pathways. A total of 127 offspring living with their parents, and the parental infection status is shown in Fig. 4A. The results indicated that the infection rate of offspring significantly increased with the progression of parental infection status (p < 0.001). Specifically, the infection rate was 18.1% in the single-parent infection group, while it significantly increased to 63.6% in the dual-parent infection group. Discussion This study systematically investigates the infection patterns of Helicobacter pylori ( H. pylori ) in patients with early gastric cancer and their families, focusing on the risk factors for infection, the transmission pathways within the family, and the dynamics of infection between spouses. The results show that the H. pylori infection rate in gastric early cancer families (96.8%) is significantly higher than the infection rate in general families (71.21%) reported by Xian-Zhu Zhou's study [ 6 ]. At the same time, the individual-based infection rate (66.3%) is lower than the family-based infection rate (96.8%) in gastric early cancer families. Many previous studies have shown that the clustering of H. pylori infections within families is closely related to socioeconomic factors, lifestyle habits, and transmission among family members. A 2017 community-based cross-sectional survey of 219 families (918 residents) in Vietnam on H. pylori infection found that high income, infrequent food chewing, and breastfeeding were protective factors, while failure to wash hands after defecation, maternal or grandfather's infection, and large family size were risk factors for children’s infection [ 22 – 23 ]. A large-scale family-based H. pylori infection survey in China covering 10,735 families across 31 provinces showed that children's infections were closely related to parental infection. A higher number of family member infections, living in high infection rate areas, and a larger family size were independent risk factors, while higher family income, education level, use of communal utensils, multi-generational families, and younger children were protective factors [ 5 ]. However, few studies have focused on the infection situation and infection patterns in special family groups. A cross-sectional study in Germany found that the H. pylori infection rate was significantly increased in the descendants of gastric cancer patients [ 24 ]. Another randomized study in San Marino showed that H. pylori serum positivity was significantly associated with digestive ulcers in patients and their close relatives, siblings with digestive ulcers, and the father’s gastric cancer. Interestingly, H. pylori serum positivity was not significantly related to the partner's gastric and duodenal diseases [ 25 ]. Therefore, the complex transmission pattern of H. pylori between special family members warrants further study. In our study of 125 gastric early cancer families, only 4 families were not infected, with the family infection rate reaching 96.8%. The analysis of risk factors for full family infection and partial infection in our study showed that the infection rate decreased with higher family income, which is consistent with previous studies. However, it was surprising that family size was inversely proportional to the risk of full family infection. This result seems contrary to common sense. A possible explanation is that members of large families usually live apart for extended periods, such as working or studying away from home, thus reducing opportunities for close contact. In contrast, small families mainly consist of the patient and their partner, and due to long-term cohabitation, the frequency of contact is higher, which increases the risk of infection in small families. In addition, the small number of households with large family members also influenced the results. Further large-scale studies are needed to clarify this phenomenon. Among all participants, the individual-based infection rate was 66.3%, higher than the individual infection rate in general families (40.7%) [ 26 ]. Family members infected with H. pylori are a continuous source of transmission and an important health threat to uninfected family members. A 2003 study in Stockholm, Sweden, using family-based DNA fingerprinting technology on bacterial isolates found that the proportion of shared strains was high among siblings and between spouses [ 27 ]. Additionally, it is related to the type of H. pylori strain. The I-type strain of H. pylori is more virulent [ 28 , 29 ]. In a 2022 study in China, 68.7% of families with all members infected had the I-type strain [ 30 ]. In the future, we need to monitor the type of H. pylori infection in families with early gastric cancer, inform family members of the pathogenic ability of infected bacteria and establish different eradication strategies. A reasonable explanation could be that the majority of people in China lack proactive awareness of Helicobacter pylori infection, especially among the general patient population. Although some health check-up units include Helicobacter pylori testing as part of their screening programs, most patients are diagnosed only after the infection is discovered during a check-up or when they seek medical attention due to gastrointestinal discomfort. Due to the low testing rate, fewer people receive eradication treatment, resulting in a continued high infection rate within the population. This is particularly true in families with a high risk of gastric cancer, where strains of the bacteria with stronger virulence are more commonly found. Unlike the Western practice of separate dining, sharing the same utensils or food is a traditional habit retained in China and other Asian countries. Saliva cultures from H. pylori -infected patients have confirmed the presence of oral H. pylori , and H. pylori DNA can be detected on chopsticks [ 31 , 32 ]. However, in our individual-based analysis, no significant decrease in infection rates was observed in families using communal chopsticks and spoons. This may be related to the special family groups in our study. For instance, these families may already have a high baseline infection rate or may have other more significant transmission routes, which diminish the intervention effect of using communal chopsticks and spoons. Additionally, some family members may not have strictly adhered to the use of communal utensils, or cross-contact might still occur in daily life, weakening the potential impact of this measure in reducing H. pylori transmission. This suggests that, while promoting the use of communal utensils, other intervention measures such as improving hygiene practices, reducing close contact, and conducting regular health education should be strengthened to more effectively control H. pylori transmission within families. Early studies have outlined the prevalence and risk factors of infection between spouses [ 8 , 33 – 34 ]. As expected, the infection rate among both spouses in families with early gastric cancer (43.8%) is higher than the infection rate in ordinary families (23.0%) [ 6 ]. The infection rate increases significantly with the duration of cohabitation, supporting transmission between spouses. Meanwhile, the infection rate among spouses decreases as income increases, indicating that H. pylori infection is also associated with socioeconomic status. These data support the idea that household transmission is the main route of transmission, but exogenous infections can also occur, suggesting the presence of multiple transmission routes. An unexpected result is that when both parents are infected, the infection rate in their offspring is 63.6%, while when only one parent is infected, the infection rate in children is 18.1%, with a statistically significant difference. Furthermore, the infection rate in offspring is the same whether the mother or father is infected, both at 18.1%. This result slightly deviates from our previous understanding that parental H. pylori infection is an independent factor for infant infection [ 5 – 9 ], with mothers playing an important role in transmitting H. pylori to their offspring. However, the current results may reflect the infection status in the study area, as the living standards, hygiene conditions, use of tap water, and practices such as avoiding chewing food for children have gradually improved in Chinese urban families over the past decades, leading to a decrease in infection rates [ 35 ]. Another possibility is that the number of offspring in the current cohort is relatively small, which may not provide enough statistical power for significance. Additionally, we were unable to perform bacterial DNA fingerprinting to confirm whether the strains were identical, so the precise genotypes of strains transmitted within a family unit remain to be determined. This is the largest study to date on H. pylori infection in gastric early cancer families, filling the research gap in the infection patterns and transmission modes within special family groups. It also emphasizes the importance of implementing family-based H. pylori infection control and management strategies in clinical practice. Our findings suggest that family-based H. pylori infection control and management, centered around the patient and covering the entire family, may lead to higher eradication rates, lower infection rates, and reduced incidence of gastrointestinal diseases. The management and control of Helicobacter pylori infection in families with a history of gastric cancer in China remains a long-term and challenging task. It requires heightened attention from early cancer diagnosis and treatment teams, along with health education, timely eradication, and stratified management, in order to effectively interrupt the high infection rate within these families and reduce the incidence of gastric cancer. This study has several limitations. First, we focused solely on families of patients with early gastric cancer, resulting in a relatively small sample size. Second,the study did not include data from endoscopic examinations, thus omitting more detailed insights into related diseases. Thirds, there was no distinction between infection strain types and genotypes. Future research should include larger sample sizes, gather more comprehensive disease-related data, and explore the types of strains to better understand the unique transmission patterns within families. Despite these limitations, this study offers new evidence regarding H. pylori infection patterns in families of early gastric cancer patients. Conclusion Our study highlights the high prevalence and unique transmission patterns of H. pylori infection within EGC families, emphasizing the importance of family-based prevention strategies. These findings provide compelling evidence supporting a shift from individual-based to family-centered H. pylori management in clinical practice[ 17 – 20 ]. By targeting high-risk families, particularly those with gastrointestinal diseases, this approach could achieve higher eradication rates, reduced infection prevalence, and lower incidences of associated gastrointestinal condition. Declarations Conflict of Interest Statement The authors declare that they have no conflicts of interest to disclose. Funding This work was funded by the Jiangsu Provincial Key Research and Development program (BE2021601). This work was supported by grants from the Jiangsu Science and Technology Project (no. BK20211039). This work was supported by grants from the Postgraduate Research & Practice Innovation Program of Jiangsu Province (no. SJCX24_1037). The funding organizations played no role in the design, analysis, or writing of this manuscript. Acknowledgements We would like to thank Zhao Tao and Sun Jingrong for their hard work in data collection. We also appreciate the careful guidance provided by Professor Xu Guifang in preparing this manuscript. Ethics approval and consent to participate This study is not a clinical trial and does not require trial registration. All procedures performed in studies involving human participants were approved by the Human Ethics Review Committees of the Nanjing Drum Tower Hospital (IRB No. 2025-0075-01). This study involving human participants was conducted in accordance with the Declaration of Helsinki, and all participants provided written informed consent prior to participation. Data Statement Availability of data and materials All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author. Author contributions M.S.T. wrote the main manuscript text and primary data analysis. Z.T. and Z.J.R. collected data and followed up with patients, and assisted in data analysis. L.M., W.H. and X.Y. provided ideas and analysis methods. X.G.F. revised and polished the manuscript and provided guidance and supervision. 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Helicobacter pylori CagA and VacA genotypes and gastric phenotype: a meta-analysis. Eur J Gastroenterol Hepatol. 2013;25:1431–1441. Yu XC, Shao QQ, Ma J, Yu M, Zhang C, Lei L, Zhou Y, Chen WC, Zhang W, Fang XH, Zhu YZ, Wu G, Wang XM, Han SY, Sun PC, Ding SZ. Family-based Helicobacter pylori infection status and transmission pattern in central China, and its clinical implications for related disease prevention. World J Gastroenterol. 2022 Jul 28;28(28):3706-3719. Wang XM, Yee KC, Hazeki-Taylor N, Li J, Fu HY, Huang ML, Zhang GY. Oral Helicobacter pylori, its relationship to successful eradication of gastric H. pylori and saliva culture confirmation. J Physiol Pharmacol. 2014 Aug;65(4):559-66. Leung WK, Sung JJ, Ling TK, Siu KL, Cheng AF. Use of chopsticks for eating and Helicobacter pylori infection. Dig Dis Sci. 1999 Jun;44(6):1173-6. Gisbert JP, Arata IG, Boixeda D, Barba M, Cantón R, Plaza AG, Pajares JM. 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Tables Table 1 Demographic Characteristics of Enrolled Households and Risk Factors for Helicobacter pylori Infection Characteristics Partially Infected （ n=84 ） All Members Infected （ n=37 ） Crude OR(95%CI) P value Adjusted OR(95%CI) P value Annual household income (thousand yuan) 300 10 (11.9%) 2 (5.4%) 0.29 (0.06-1.43) 0.130 0.27 (0.05-1.49) 0.134 Resident location City 42 (50%) 22 (59.5%) Reference Urban−Rural Combined 17 (20.2%) 10 (27%) 1.12 (0.44-2.86) 0.808 Rural 25 (29.8%) 5 (13.5%) 0.38 (0.13-1.14) 0.083 Household living area (m2) <60 8 (9.5%) 2 (5.4%) Reference 60-120 34 (40.5%) 23 (62.2%) 2.71 (0.53-13.91) 0.233 ＞120 42 (50%) 12 (32.4%) 1.14 (0.21-6.11) 0.876 Pets in household No 68 (81%) 27 (73%) Reference Yes 16 (19%) 10 (27%) 1.57 (0.64-3.90) 0.327 Sources of drinking water Boiled water 65 (77.4%) 30 (81.1%) Reference Raw water 3 (3.6%) 1 (2.7%) 0.72 (0.07-7.23) 0.782 Bottled water 2 (2.4%) 1 (2.7%) 1.08 (0.09-12.42) 0.949 Purified water 14 (16.7%) 5 (13.5%) 0.77 (0.26-2.35) 0.650 Dish washing Tap water 76 (90.5%) 33 (89.2%) Reference In a basin 8 (9.5%) 4 (10.8%) 1.15 (0.32-4.09) 0.827 Tableware sterilisation No sterilisation 56 (66.7%) 25 (67.6%) Reference Disinfection cabinet 19 (22.6%) 10 (27%) 1.18 (0.48-2.90) 0.720 Other disinfection methods 9 (10.7%) 2 (5.4%) 0.50 (0.10-2.47) 0.394 Shared household items Chopsticks and spoons 75 (89.3%) 33 (89.2%) Reference Water cup 5 (6%) 2 (5.4%) 0.91 (0.17-4.93) 0.912 Dental mouthwash cup 4 (4.8%) 2 (5.4%) 1.14 (0.20-6.51) 0.886 Dish sharing Yes 4 (4.8%) 4 (10.8%) Reference No 80 (95.2%) 33 (89.2%) 0.41 (0.10-1.75) 0.229 Serving chopsticks and spoons Yes 14 (16.7%) 10 (27%) Reference No 70 (83.3%) 27 (73%) 0.54 (0.21-1.36) 0.192 Family size (n) 2 7 (8.3%) 14 (37.8%) Reference 3 43 (51.2%) 11 (29.7%) 0.13 (0.04-0.39) <.001 0.13 (0.04-0.42) <.001 4 25 (29.8%) 10 (27%) 0.20 (0.06-0.64) 0.007 0.23 (0.07-0.76) 0.017 5 4 (4.8%) 1 (2.7%) 0.12 (0.01-1.34) 0.086 0.24 (0.02-2.98) 0.266 6 4 (4.8%) 1 (2.7%) 0.13 (0.01-1.34) 0.086 0.17 (0.01-2.02) 0.161 7 1 (1.2%) 0 (0%) 0.00 (0.00-Inf) 0.991 0.00 (0.00-Inf ) 0.991 Table 2 Demographic information of enrolled individuals and Helicobacter pylori infection risk factors Characteristics Uninfected Infected Crude OR(95%CI) P value Adjusted OR(95%CI) P value Sex Male 72 (43.1%) 131 (51.6%) Reference Female 95 (56.9%) 123 (48.4%) 0.71 (0.48-1.05) 0.090 Age (Mean ± SD) 47.8 ± 14.3 56.2 ± 14.7 1.04 (1.02-1.05) <0.001 1.05 (1.03-1.08) <0.001 Marital status Single 10 (6%) 13 (5.1%) Reference Reference Married 157 (94%) 241 (94.9%) 1.18 (0.51-2.76) 0.701 Occupation Worker 47 (28.1%) 60 (23.6%) Reference Reference Farmer 12 (7.2%) 41 (16.1%) 2.68 (1.27-5.65) 0.010 3.36 (1.23-9.19) 0.018 Teacher 10 (6%) 7 (2.8%) 0.55 (0.19-1.55) 0.257 1.10 (0.25-4.84) 0.898 Management/technical personnel 30 (18%) 23 (9.1%) 0.60 (0.31-1.17) 0.132 0.87 (0.31-2.44) 0.793 Doctor 5 (3%) 6 (2.4%) 0.94 (0.27-3.27) 0.922 1.60 (0.28-8.99) 0.593 Student 1 (0.6%) 2 (0.8%) 1.57 (0.14-17.81) 0.717 13.61 (0.36-512.14) 0.158 Freelancer 62 (37.1%) 115 (45.3%) 1.45 (0.89-2.37) 0.136 2.05 (1.03-4.09) 0.040 Education level Compulsory education stage 70 (41.9%) 149 (58.7%) Reference Reference High school 94 (56.3%) 88 (34.6%) 0.44 (0.29-0.66) <0.001 1.11 (0.55-2.23) 0.779 College and above 3 (1.8%) 17 (6.7%) 2.66 (0.76-9.38) 0.128 1.07 (0.20-5.73) 0.940 Drinking tap water No 13 (7.8%) 23 (9.1%) Reference Yes 154 (92.2%) 231 (90.9%) 0.85 (0.42-1.72, p=.649) Washing hands before meal and after defecation No 157 (94%) 234 (92.1%) Reference Yes 10 (6%) 20 (7.9%) 1.34 (0.61-2.94, p=.463) Dining at road side restaurant Rare 92 (55.1%) 151 (59.4%) Reference Frequent 75 (44.9%) 103 (40.6%) 0.84 (0.56-1.24, p=.376) No. of infected family members exposed 0 112 (67.1%) 47 (18.5%) Reference Reference 1 44 (26.3%) 86 (33.9%) 4.66 (2.83-7.66) <0.001 5.89 (3.16-10.97) <0.001 2 6 (3.6%) 51 (20.1%) 20.26 (8.14-50.42) <0.001 53.77 (17.99-160.69) <0.001 3 2 (1.2%) 43 (16.9%) 51.23 (11.92-220.16) <0.001 149.84 (29.87-751.63) <0.001 4 2 (1.2%) 15 (5.9%) 17.87 (3.93-81.25) <0.001 35.68 (6.58-193.32, p<.001) <0.001 5 1 (0.6%) 12 (4.7%) 28.60 (3.61-226.22) 0.002 46.11 (4.16-510.83) 0.002 Gastrointestinal symptoms within last 1 year No 133 (79.6%) 111 (43.7%) Reference Reference Yes 34 (20.4%) 143 (56.3%) 5.04 (3.21-7.91) <0.001 4.85 (2.68-8.77) <0.001 Household residence duration （years） <5 7 (4.2%) 5 (2%) Reference ≥5 12 (7.2%) 8 (3.1%) 0.93 (0.22-4.00) 0.926 ≥15 61 (36.5%) 44 (17.3%) 1.01 (0.30-3.39) 0.987 ≥30 87 (52.1%) 197 (77.6%) 3.17 (0.98-10.27) 0.054 Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 27 Jun, 2025 Reviews received at journal 25 Jun, 2025 Reviews received at journal 25 Jun, 2025 Reviewers agreed at journal 21 Jun, 2025 Reviewers agreed at journal 21 Jun, 2025 Reviewers invited by journal 20 Jun, 2025 Editor assigned by journal 20 Jun, 2025 Submission checks completed at journal 16 Jun, 2025 First submitted to journal 15 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6897943","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":474710025,"identity":"5b3dae5f-caf7-4330-9f50-1699332c6b87","order_by":0,"name":"Shangtao Mao","email":"","orcid":"","institution":"Affiliated Drum Tower Hospital of Nanjing University Medical School","correspondingAuthor":false,"prefix":"","firstName":"Shangtao","middleName":"","lastName":"Mao","suffix":""},{"id":474710026,"identity":"d14b458f-d695-40e6-9154-4c00f4f9664f","order_by":1,"name":"Tao Zhao","email":"","orcid":"","institution":"Affiliated Taikang Xianlin Drum 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11:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6897943/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6897943/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85349876,"identity":"e8a85158-635b-45cb-9995-466b959e1405","added_by":"auto","created_at":"2025-06-25 02:44:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":504135,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of household and individual enrolment processes.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6897943/v1/63914685e4f68427d4657371.png"},{"id":85349229,"identity":"daea45ab-9b3c-480f-abcd-4ef7c86866bf","added_by":"auto","created_at":"2025-06-25 02:36:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":117833,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eH. pylori\u003c/em\u003e Infection Distribution and Rates Across Different Age Groups Among Enrolled Participants\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-6897943/v1/7e5bde0ca1e73e1686cbc658.png"},{"id":85349228,"identity":"1ab84148-11a4-4974-9bd4-c3f784cc99ef","added_by":"auto","created_at":"2025-06-25 02:36:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":316359,"visible":true,"origin":"","legend":"\u003cp\u003eStratified analysis of Helicobacter pylori infection in the enrolled families. (A)The correlation between annual household income stratification and \u003cem\u003eH. pylori\u003c/em\u003e infection rates. *p\u0026lt;0.05 , **p\u0026lt;0.01, **p\u0026lt;0.01, ***p\u0026lt;0.001 when infection rates between the two groups were compared. NS when these groups were compared with each other, p\u0026gt;0.05. (B)Infection status among 125 early gastric cancer households, with the y-axis representing household size (ranging from 2 to 5 or more members) and the x-axis indicating the number of infected individuals within the household. The numbers within the squares represent the count of infected households, while the percentages inside parentheses and along the curve denote the proportion of infected households within the same household size group.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-6897943/v1/ce73d356e18bd733f1efb7a6.png"},{"id":85349234,"identity":"d9bf6a20-23ad-4215-b86f-2d6350cdfae4","added_by":"auto","created_at":"2025-06-25 02:36:45","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":553062,"visible":true,"origin":"","legend":"\u003cp\u003eStratified analysis of Helicobacter pylori infection in the enrolled couples. (A) Distribution of couples number per household in 125 enrolled families; y axis represents the number of family, and x axis represents the number of couples within the family. (B) Infection status of the total 153 couples; y axis represents the number of couples, and x axis indicates the infection status of these couples. (C) Correlation of couple cohabitation time and H. pylori infection rate of 153 couples. (D) Correlation of annual household income and couple infection status. *p\u0026lt;0.05 , **p\u0026lt;0.01, **p\u0026lt;0.01, ***p\u0026lt;0.001when infection rates between the two groups were compared. NS when these groups were compared with each other, p\u0026gt;0.05.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-6897943/v1/ab1cf42544b7e2c541a8f40b.png"},{"id":85349877,"identity":"0f01a018-3159-4e47-8b31-87043e9368e9","added_by":"auto","created_at":"2025-06-25 02:44:44","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":4493,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStratified analysis of Helicobacter pylori infection in offspring. (A) Parental infection status of 127 offspring who cohabitated with them, y axis represents offspring number, and x axis indicates H. pylori infection status of these parents. (B) Correlation of parental infection status and offspring infection rate, y axis represents the infection rate, x axis indicates H. pylori infection status of these parents. ***p\u0026lt;0.001 when infection rates between the two groups were compared.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig.png","url":"https://assets-eu.researchsquare.com/files/rs-6897943/v1/a8e487cd48d98b8865d95824.png"},{"id":85351060,"identity":"5354dc79-cecf-4d22-a064-558915bc4c1b","added_by":"auto","created_at":"2025-06-25 03:00:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2749154,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6897943/v1/0257c46b-3f55-4277-896e-248d8065134a.pdf"},{"id":85349227,"identity":"4d312496-df52-401c-8322-a57acfbe6820","added_by":"auto","created_at":"2025-06-25 02:36:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":55982,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6897943/v1/daaf7a0ec16dbbc5e465fa27.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eInfection Characteristics and Transmission Patterns of Helicobacter pylori in Families of Early Gastric Cancer Patients\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGastric cancer is the third leading cause of cancer death worldwide, contributing to about 8% of cancer-related deaths [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The development of many cases of gastric cancer are related to Helicobacter pylori infection. Chronic Helicobacter pylori infection leads to a sequence of events, including chronic atrophic gastritis and gastric cancer [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Approximately 4.4\u0026nbsp;billion people worldwide are infected with H. pylori, with significant regional variations in infection rates [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In China, the primary transmission routes is intra-familial transmission and the risk of H. pylori infection is higher with the number of infected members [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In particular, infected parents, especially mothers, who are central to child-rearing, play a critical role in facilitating intra-familial transmission [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe infection rate in Chinese residents is approximately 44.2%, with the prevalence increasing with age, from 28.0% in children and adolescents to 46.1% in adults [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The annual incidence of gastric cancer in China is 20.2 per 100,000 people, and the mortality rate is 14.7 per 100,000, respectively [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. H. pylori infection remains a major cause of gastric cancer in China, accounting for 40.7% of cardia gastric cancer and 62.1% of non-cardia gastric cancer cases [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Stratified analyses indicate that intra-familial transmission is a key mode of H. pylori infection in China [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLarge-scale clinical studies and international consensus reports recommend screening and eradicating H. pylori in populations from high-infection regions as a preventive measure for gastric cancer [\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Currently, the approach to H. pylori control is shifting from individual prevention and treatment strategies to family-based infection control strategies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In 2021, China introduced the \"Chinese Consensus Report on Family-Based Helicobacter pylori Infection Control and Management \"[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This consensus advocates for a family-centered approach to controlling H. pylori infection.\u003c/p\u003e \u003cp\u003eDespite increasing attention to the issue of familial H. pylori infection with the advancement of clinical practice and understanding, no studies have yet focused on investigating H. pylori infection within the families of early gastric cancer patients. Since China is one of the regions where both H. pylori infection and gastric cancer are highly prevalent, it is very important to elucidate the infection patterns of Helicobacter pylori within families of early gastric cancer for the control of the early gastric cancer. This study will conduct a questionnaire survey targeting the families of early gastric cancer patients to explore the infection status, risk factors, and transmission routes within these households. Such investigations will provide critical evidence for addressing high-risk family infections, contributing to the development of eradication strategies for infection control and disease prevention centered around gastric cancer patients. Ultimately, this will help reduce the risk of gastric cancer.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participant enrollment\u003c/h2\u003e \u003cp\u003eThis family-based survey was conducted from June to December 2024 at Nanjing Drum Tower Hospital. Participants were family members cohabiting with gastric early cancer patients who visited the outpatient clinic, were re-examined, or were admitted for treatment. Families with two or more members were invited to participate in the survey. A family could consist of a couple, with or without children, multiple generations of couples, or single parents with children, without a limit on the maximum number of family members living together.\u003c/p\u003e \u003cp\u003eTo ensure the accuracy of the 13C urea breath test and avoid false-negative results, the following exclusion criteria were applied: (1) Family members who had used antibiotics within the past month, (2) Family members who had used proton pump inhibitors within the past two weeks, (3) Family members who had previously undergone treatment for \u003cem\u003eH. pylori\u003c/em\u003e within the past three months, (4) Individuals with severe heart, liver, or kidney dysfunction, and (5) those with contraindications for \u003cem\u003eH. pylori\u003c/em\u003e testing. However, family members who had successfully eradicated \u003cem\u003eH. pylori\u003c/em\u003e more than three months ago were eligible for inclusion.\u003c/p\u003e \u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Nanjing Drum Tower Hospital (IRB No. 2025-0075-01).\u003c/p\u003e \u003cp\u003e \u003cb\u003eHelicobacter pylori\u003c/b\u003e \u003cb\u003eTesting for Family Members\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFamily members participating in the survey who had previously undergone Helicobacter pylori testing were required to upload their test reports or documentation to an app for centralized collection, review, verification, and management. Family members who had not undergone Helicobacter pylori testing were required to undergo the \u003csup\u003e13\u003c/sup\u003eC urea breath test at the outpatient clinic and subsequently upload their test reports. We ensured that every participating family member completed the necessary Helicobacter pylori testing.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDefinitions\u003c/h3\u003e\n\u003cp\u003eInfected households are defined as those with at least one infected member, whereas uninfected households are those where all members tested negative for \u003cem\u003eH. pylori\u003c/em\u003e. Partial infection refers to a family in which at least one member is not infected with \u003cem\u003eH. pylori\u003c/em\u003e. Complete infection is defined as a family in which all members are infected with \u003cem\u003eH. pylori\u003c/em\u003e. In the stratified analysis of couples, single partner infection refers to couples where only one partner is infected with Helicobacter pylori.\u003c/p\u003e\n\u003ch3\u003eFamily Member Questionnaire Survey\u003c/h3\u003e\n\u003cp\u003eParticipation in the survey was voluntary for gastric early cancer patients, with no special rewards offered. The survey questionnaire is designed with reference to the 2023 study by Xian-Zhu Zhou [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].All family members of the patients were required to participate. Trained doctors assisted on-site with the registration process and survey completion (Supplementary File 1). For each eligible family, members were asked to complete a questionnaire. The head of the household was responsible for providing information about the family, including the number of family members, annual income, living area, household hygiene, and conditions related to animal rearing. Data auditors verified and calibrated the information provided. All data were kept confidential and were used solely for analysis.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are presented as medians and interquartile ranges (IQR) or as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and analyzed using t-tests or Mann-Whitney U tests, as appropriate. Categorical variables are reported as frequencies (percentages) and compared using Pearson's chi-square test or Fisher's exact test. All variables on univariate analysis with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were included in the multivariate logistic regression analysis. Statistical analyses were conducted using SPSS version 26.0 and R version 4.2.3, with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-sided) considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eGeneral Characteristics of Included Families and Individual Members\u003c/h2\u003e\n \u003cp\u003eFlow chart of family enrollment information is shown in Fig. 1. A total of 176 families completed the questionnaire survey, among which 125 families were included in the study after screening. The analysis encompassed 421 members from these families. The mean age of the study population was 52.9 years, with 203 males (48.2%) and 218 females (51.8%). There were 254 cases of \u003cem\u003eH. pylori\u003c/em\u003e infection, and the overall individual infection rate for \u003cem\u003eH. pylori\u003c/em\u003e was 60.33%. The average household size among the 125 enrolled families was 3.35 members. Of these, 121 (96.8%) families had at least one infected member.A significant association was observed between age and \u003cem\u003eH. pylori\u003c/em\u003e infection across different age groups, with the infection rate increasing with age among adults (Fig. 2). In families with early gastric cancer, the \u003cem\u003eH. pylori\u003c/em\u003e infection rate increases rapidly in individuals over the age of 40.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold\u003c/strong\u003e \u003cstrong\u003eH. pylori\u003c/strong\u003e \u003cstrong\u003eInfection Status and Risk Factors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAmong the 125 families included in the study, the distribution of household sizes was as follows: 21 two-member households (16.8%), 57 three-member households (45.6%), 36 four-member households (28.8%), 5 five-member households (4.0%), 5 six-member households (4.0%), and 1 seven-member household (0.8%). Of these households, 3.2% had no infected members, while 14.0% had all members infected. Partial infection among household members was observed in 84 households (67.2%), and complete infection was observed in 37 households (29.6%). Table\u0026nbsp;1 presents the infection rates and risk factor analysis for households with partial and complete infection.\u003c/p\u003e\n \u003cp\u003eHigher household income was associated with a lower risk of infection. After adjustment, households with an annual income of 100,000\u0026ndash;300,000 CNY had a significantly lower infection risk (adjusted OR\u0026thinsp;=\u0026thinsp;0.26, 95% CI: 0.08\u0026ndash;0.80, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019). Although households with an income exceeding 300,000 CNY also showed a trend toward reduced risk, the association did not reach statistical significance (adjusted OR\u0026thinsp;=\u0026thinsp;0.27, 95% CI: 0.05\u0026ndash;1.49, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.134). Stratified analysis revealed that low-income households had higher complete infection rates, whereas the reverse was true for high-income households (Fig.\u0026nbsp;2A). Interestingly, household size was inversely associated with the risk of complete household infection, which appears counterintuitive. (with an all-members infection rate of 66.67% in two-member households) (Fig.\u0026nbsp;2B).\u003c/p\u003e\n \u003cp\u003eOther factors, such as place of residence, household living area, source of drinking water, methods of tableware cleaning and disinfection, sharing of utensils, and the use of communal chopsticks, did not show a significant association with infection risk (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), which may be attributed to the limited sample size.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIndividual-based\u003c/strong\u003e \u003cstrong\u003eH.pylori\u003c/strong\u003e \u003cstrong\u003einfection status and risk factors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe individual-level infection status and associated risk factors are presented in Table\u0026nbsp;2. Older age, occupations such as farming and freelancing, exposure to infected household members, and a history of gastrointestinal discomfort were associated with a significantly higher risk of infection (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cp\u003eIn multivariable logistic regression analysis, age emerged as a significant independent risk factor, with infection risk increasing with advancing age (Adjusted OR\u0026thinsp;=\u0026thinsp;1.05, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Infection was strongly associated with the presence of infected household members (e.g., households with five infected members: OR\u0026thinsp;=\u0026thinsp;46.11, 95% CI: 4.16\u0026ndash;510.83, p\u0026thinsp;=\u0026thinsp;0.002). Additionally, farming (OR\u0026thinsp;=\u0026thinsp;3.36, 95% CI: 1.23\u0026ndash;9.19, p\u0026thinsp;=\u0026thinsp;0.018), freelancing (OR\u0026thinsp;=\u0026thinsp;2.05, 95% CI: 1.03\u0026ndash;4.09, p\u0026thinsp;=\u0026thinsp;0.040), and a history of gastrointestinal discomfort (OR\u0026thinsp;=\u0026thinsp;4.85, 95% CI: 2.68\u0026ndash;8.77, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were identified as independent risk factors for H. pylori infection.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eH. pylori\u003c/strong\u003e \u003cstrong\u003eInfection Status and Risk Factors Among Couples\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTo further investigate the risk factors and transmission patterns among couples, we analyzed the infection status within this population. Among the 125 families, 79 families (55.8%) included one couple, 34 families (27.2%) included two couples, and 2 families (1.6%) included three couples (Fig.\u0026nbsp;3A). Additionally, 10 families (8.0%) consisted of only a husband or wife. Among the 153 couples, 67 couples (43.8%) were both infected with H. pylori, while 22 couples (14.4%) were both uninfected. The remaining couples had one partner infected (Fig.\u0026nbsp;3B). In cases where one spouse is infected, infection in the husband is more commonly observed.\u003c/p\u003e\n \u003cp\u003eThe infection rate increased with the duration of cohabitation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with couples who had cohabited for shorter durations exhibiting lower infection rates, whereas those with longer cohabitation durations exhibited higher rates (Fig.\u0026nbsp;3C). Couples who had cohabited for shorter durations (0\u0026ndash;5 years) exhibited the lowest infection rates, with only 3.0% of couples both infected, 6.7% with a single infected partner, and 18.2% with no infection. In contrast, couples who have cohabited for \u0026gt;\u0026thinsp;30 years showed a significantly higher infection rate, 80.9% have both partners infected, 58.9% have one partner infected, and 4.5% have no infection.\u003c/p\u003e\n \u003cp\u003eFurthermore, a general trend of decreasing H. pylori infection rates with increasing household income was observed (Fig. 3D). Couples with an annual household income\u0026thinsp;\u0026lt;\u0026thinsp;100 thousand yuan had the highest infection rates, with 65.7% of couples being both infected. In comparison, couples with incomes\u0026thinsp;\u0026gt;\u0026thinsp;300 thousand yuan showed a lower infection rate of 10.4% of couples both infected.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eH. pylori\u003c/strong\u003e \u003cstrong\u003eInfection Status in Offspring\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTo investigate the infection status of \u003cem\u003eH. pylori\u003c/em\u003e in offspring and its relationship with parental infection status, we further analyzed the infection rates of offspring and potential intrafamilial transmission pathways. A total of 127 offspring living with their parents, and the parental infection status is shown in Fig. 4A. The results indicated that the infection rate of offspring significantly increased with the progression of parental infection status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Specifically, the infection rate was 18.1% in the single-parent infection group, while it significantly increased to 63.6% in the dual-parent infection group.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study systematically investigates the infection patterns of Helicobacter pylori (\u003cem\u003eH. pylori\u003c/em\u003e) in patients with early gastric cancer and their families, focusing on the risk factors for infection, the transmission pathways within the family, and the dynamics of infection between spouses. The results show that the \u003cem\u003eH. pylori\u003c/em\u003e infection rate in gastric early cancer families (96.8%) is significantly higher than the infection rate in general families (71.21%) reported by Xian-Zhu Zhou's study [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. At the same time, the individual-based infection rate (66.3%) is lower than the family-based infection rate (96.8%) in gastric early cancer families.\u003c/p\u003e \u003cp\u003eMany previous studies have shown that the clustering of \u003cem\u003eH. pylori\u003c/em\u003e infections within families is closely related to socioeconomic factors, lifestyle habits, and transmission among family members. A 2017 community-based cross-sectional survey of 219 families (918 residents) in Vietnam on \u003cem\u003eH. pylori\u003c/em\u003e infection found that high income, infrequent food chewing, and breastfeeding were protective factors, while failure to wash hands after defecation, maternal or grandfather's infection, and large family size were risk factors for children\u0026rsquo;s infection [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A large-scale family-based \u003cem\u003eH. pylori\u003c/em\u003e infection survey in China covering 10,735 families across 31 provinces showed that children's infections were closely related to parental infection. A higher number of family member infections, living in high infection rate areas, and a larger family size were independent risk factors, while higher family income, education level, use of communal utensils, multi-generational families, and younger children were protective factors [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, few studies have focused on the infection situation and infection patterns in special family groups. A cross-sectional study in Germany found that the \u003cem\u003eH. pylori\u003c/em\u003e infection rate was significantly increased in the descendants of gastric cancer patients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Another randomized study in San Marino showed that \u003cem\u003eH. pylori\u003c/em\u003e serum positivity was significantly associated with digestive ulcers in patients and their close relatives, siblings with digestive ulcers, and the father\u0026rsquo;s gastric cancer. Interestingly, \u003cem\u003eH. pylori\u003c/em\u003e serum positivity was not significantly related to the partner's gastric and duodenal diseases [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Therefore, the complex transmission pattern of \u003cem\u003eH. pylori\u003c/em\u003e between special family members warrants further study. In our study of 125 gastric early cancer families, only 4 families were not infected, with the family infection rate reaching 96.8%. The analysis of risk factors for full family infection and partial infection in our study showed that the infection rate decreased with higher family income, which is consistent with previous studies. However, it was surprising that family size was inversely proportional to the risk of full family infection. This result seems contrary to common sense. A possible explanation is that members of large families usually live apart for extended periods, such as working or studying away from home, thus reducing opportunities for close contact. In contrast, small families mainly consist of the patient and their partner, and due to long-term cohabitation, the frequency of contact is higher, which increases the risk of infection in small families. In addition, the small number of households with large family members also influenced the results. Further large-scale studies are needed to clarify this phenomenon.\u003c/p\u003e \u003cp\u003eAmong all participants, the individual-based infection rate was 66.3%, higher than the individual infection rate in general families (40.7%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Family members infected with \u003cem\u003eH. pylori\u003c/em\u003e are a continuous source of transmission and an important health threat to uninfected family members. A 2003 study in Stockholm, Sweden, using family-based DNA fingerprinting technology on bacterial isolates found that the proportion of shared strains was high among siblings and between spouses [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Additionally, it is related to the type of \u003cem\u003eH. pylori\u003c/em\u003e strain. The I-type strain of \u003cem\u003eH. pylori\u003c/em\u003e is more virulent [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In a 2022 study in China, 68.7% of families with all members infected had the I-type strain [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In the future, we need to monitor the type of \u003cem\u003eH. pylori\u003c/em\u003e infection in families with early gastric cancer, inform family members of the pathogenic ability of infected bacteria and establish different eradication strategies. A reasonable explanation could be that the majority of people in China lack proactive awareness of Helicobacter pylori infection, especially among the general patient population. Although some health check-up units include Helicobacter pylori testing as part of their screening programs, most patients are diagnosed only after the infection is discovered during a check-up or when they seek medical attention due to gastrointestinal discomfort. Due to the low testing rate, fewer people receive eradication treatment, resulting in a continued high infection rate within the population. This is particularly true in families with a high risk of gastric cancer, where strains of the bacteria with stronger virulence are more commonly found.\u003c/p\u003e \u003cp\u003eUnlike the Western practice of separate dining, sharing the same utensils or food is a traditional habit retained in China and other Asian countries. Saliva cultures from \u003cem\u003eH. pylori\u003c/em\u003e-infected patients have confirmed the presence of oral \u003cem\u003eH. pylori\u003c/em\u003e, and \u003cem\u003eH. pylori\u003c/em\u003e DNA can be detected on chopsticks [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, in our individual-based analysis, no significant decrease in infection rates was observed in families using communal chopsticks and spoons. This may be related to the special family groups in our study. For instance, these families may already have a high baseline infection rate or may have other more significant transmission routes, which diminish the intervention effect of using communal chopsticks and spoons. Additionally, some family members may not have strictly adhered to the use of communal utensils, or cross-contact might still occur in daily life, weakening the potential impact of this measure in reducing \u003cem\u003eH. pylori\u003c/em\u003e transmission. This suggests that, while promoting the use of communal utensils, other intervention measures such as improving hygiene practices, reducing close contact, and conducting regular health education should be strengthened to more effectively control \u003cem\u003eH. pylori\u003c/em\u003e transmission within families.\u003c/p\u003e \u003cp\u003eEarly studies have outlined the prevalence and risk factors of infection between spouses [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. As expected, the infection rate among both spouses in families with early gastric cancer (43.8%) is higher than the infection rate in ordinary families (23.0%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The infection rate increases significantly with the duration of cohabitation, supporting transmission between spouses. Meanwhile, the infection rate among spouses decreases as income increases, indicating that H. pylori infection is also associated with socioeconomic status. These data support the idea that household transmission is the main route of transmission, but exogenous infections can also occur, suggesting the presence of multiple transmission routes.\u003c/p\u003e \u003cp\u003eAn unexpected result is that when both parents are infected, the infection rate in their offspring is 63.6%, while when only one parent is infected, the infection rate in children is 18.1%, with a statistically significant difference. Furthermore, the infection rate in offspring is the same whether the mother or father is infected, both at 18.1%. This result slightly deviates from our previous understanding that parental \u003cem\u003eH. pylori\u003c/em\u003e infection is an independent factor for infant infection [\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], with mothers playing an important role in transmitting \u003cem\u003eH. pylori\u003c/em\u003e to their offspring. However, the current results may reflect the infection status in the study area, as the living standards, hygiene conditions, use of tap water, and practices such as avoiding chewing food for children have gradually improved in Chinese urban families over the past decades, leading to a decrease in infection rates [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Another possibility is that the number of offspring in the current cohort is relatively small, which may not provide enough statistical power for significance. Additionally, we were unable to perform bacterial DNA fingerprinting to confirm whether the strains were identical, so the precise genotypes of strains transmitted within a family unit remain to be determined.\u003c/p\u003e \u003cp\u003eThis is the largest study to date on \u003cem\u003eH. pylori\u003c/em\u003e infection in gastric early cancer families, filling the research gap in the infection patterns and transmission modes within special family groups. It also emphasizes the importance of implementing family-based \u003cem\u003eH. pylori\u003c/em\u003e infection control and management strategies in clinical practice. Our findings suggest that family-based \u003cem\u003eH. pylori\u003c/em\u003e infection control and management, centered around the patient and covering the entire family, may lead to higher eradication rates, lower infection rates, and reduced incidence of gastrointestinal diseases. The management and control of Helicobacter pylori infection in families with a history of gastric cancer in China remains a long-term and challenging task. It requires heightened attention from early cancer diagnosis and treatment teams, along with health education, timely eradication, and stratified management, in order to effectively interrupt the high infection rate within these families and reduce the incidence of gastric cancer.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, we focused solely on families of patients with early gastric cancer, resulting in a relatively small sample size. Second,the study did not include data from endoscopic examinations, thus omitting more detailed insights into related diseases. Thirds, there was no distinction between infection strain types and genotypes. Future research should include larger sample sizes, gather more comprehensive disease-related data, and explore the types of strains to better understand the unique transmission patterns within families. Despite these limitations, this study offers new evidence regarding \u003cem\u003eH. pylori\u003c/em\u003e infection patterns in families of early gastric cancer patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study highlights the high prevalence and unique transmission patterns of \u003cem\u003eH. pylori\u003c/em\u003e infection within EGC families, emphasizing the importance of family-based prevention strategies. These findings provide compelling evidence supporting a shift from individual-based to family-centered \u003cem\u003eH. pylori\u003c/em\u003e management in clinical practice[\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. By targeting high-risk families, particularly those with gastrointestinal diseases, this approach could achieve higher eradication rates, reduced infection prevalence, and lower incidences of associated gastrointestinal condition.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the Jiangsu Provincial Key Research and Development program (BE2021601). This work was supported by grants from the Jiangsu Science and Technology Project (no. BK20211039). This work was supported by grants from the Postgraduate Research \u0026amp; Practice Innovation Program of Jiangsu Province (no. SJCX24_1037). The funding organizations played no role in the design, analysis, or writing of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Zhao Tao and Sun Jingrong for their hard work in data collection. We also appreciate the careful guidance provided by Professor Xu Guifang in preparing this manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is not a clinical trial and does not require trial registration. All procedures performed in studies involving human participants were approved by the Human Ethics Review Committees of the Nanjing Drum Tower Hospital (IRB No. 2025-0075-01). This study involving human participants was conducted in accordance with the Declaration of Helsinki, and all participants provided written informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.S.T. wrote the main manuscript text and primary data analysis. Z.T. and Z.J.R. collected data and followed up with patients, and assisted in data analysis. L.M., W.H. and X.Y. provided ideas and analysis methods. X.G.F. revised and polished the manuscript and provided guidance and supervision. W.L. and Y.Q. provided insightful guidance. All authors reviewed the manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229-263. \u003c/li\u003e\n\u003cli\u003eCorrea P, Haenszel W, Cuello C, Tannenbaum S, Archer M. A model for gastric cancer epidemiology. Lancet. 1975 Jul 12;2(7924):58-60. \u003c/li\u003e\n\u003cli\u003eHooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, Malfertheiner P, Graham DY, Wong VWS, Wu JCY, Chan FKL, Sung JJY, Kaplan GG, Ng SC. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017 Aug;153(2):420-429.\u003c/li\u003e\n\u003cli\u003eParsonnet J, Shmuely H, Haggerty T. Fecal and oral shedding of Helicobacter pylori from healthy infected adults. JAMA. 1999 Dec 15;282(23):2240-5.\u003c/li\u003e\n\u003cli\u003ePerry S, de la Luz Sanchez M, Yang S, Haggerty TD, Hurst P, Perez-Perez G, Parsonnet J. Gastroenteritis and transmission of Helicobacter pylori infection in households. Emerg Infect Dis. 2006 Nov;12(11):1701-8.\u003c/li\u003e\n\u003cli\u003eZhou XZ, Lyu NH, Zhu HY, Cai QC, Kong XY, Xie P, Zhou LY, Ding SZ, Li ZS, Du YQ; National Clinical Research Center for Digestive Diseases (Shanghai), Gastrointestinal Early Cancer Prevention \u0026amp; Treatment Alliance of China (GECA), Helicobacter pylori Study Group of Chinese Society of Gastroenterology and Chinese Alliance for Helicobacter pylori Study.. Large-scale, national, family-based epidemiological study on Helicobacter pylori infection in China: the time to change practice for related disease prevention. Gut. 2023 May;72(5):855-869.\u003c/li\u003e\n\u003cli\u003eNguyen VB, Nguyen GK, Phung DC, Okrainec K, Raymond J, Dupond C, Kremp O, Kalach N, Vidal-Trecan G. Intra-familial transmission of Helicobacter pylori infection in children of households with multiple generations in Vietnam. Eur J Epidemiol. 2006;21(6):459-63.\u003c/li\u003e\n\u003cli\u003eBrenner H, Weyermann M, Rothenbacher D. Clustering of Helicobacter pylori infection in couples: differences between high- and low-prevalence population groups. Ann Epidemiol. 2006 Jul;16(7):516-20.\u003c/li\u003e\n\u003cli\u003eYang YJ, Sheu BS, Lee SC, Yang HB, Wu JJ. Children of Helicobacter pylori-infected dyspeptic mothers are predisposed to H. pylori acquisition with subsequent iron deficiency and growth retardation. Helicobacter. 2005 Jun;10(3):249-55. \u003c/li\u003e\n\u003cli\u003eKonno M, Yokota S, Suga T, Takahashi M, Sato K, Fujii N. Predominance of mother-to-child transmission of Helicobacter pylori infection detected by random amplified polymorphic DNA fingerprinting analysis in Japanese families. Pediatr Infect Dis J. 2008 Nov;27(11):999-1003. \u003c/li\u003e\n\u003cli\u003eGarg PK, Perry S, Sanchez L, Parsonnet J. Concordance of Helicobacter pylori infection among children in extended-family homes. Epidemiol Infect. 2006 Jun;134(3):450-9. \u003c/li\u003e\n\u003cli\u003eRen S, Cai P, Liu Y, Wang T, Zhang Y, Li Q, Gu Y, Wei L, Yan C, Jin G. Prevalence of Helicobacter pylori infection in China: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2022 Mar;37(3):464-470. \u003c/li\u003e\n\u003cli\u003eHe F, Wang S, Zheng R, Gu J, Zeng H, Sun K, Chen R, Li L, Han B, Li X, Wei W, He J. Trends of gastric cancer burdens attributable to risk factors in China from 2000 to 2050. Lancet Reg Health West Pac. 2024 Jan 6;44:101003. \u003c/li\u003e\n\u003cli\u003eChiang TH, Chang WJ, Chen SL, Yen AM, Fann JC, Chiu SY, Chen YR, Chuang SL, Shieh CF, Liu CY, Chiu HM, Chiang H, Shun CT, Lin MW, Wu MS, Lin JT, Chan CC, Graham DY, Chen HH, Lee YC. Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands. Gut. 2021 Feb;70(2):243-250. \u003c/li\u003e\n\u003cli\u003eLi WQ, Ma JL, Zhang L, Brown LM, Li JY, Shen L, Pan KF, Liu WD, Hu Y, Han ZX, Crystal-Mansour S, Pee D, Blot WJ, Fraumeni JF Jr, You WC, Gail MH. Effects of Helicobacter pylori treatment on gastric cancer incidence and mortality in subgroups. J Natl Cancer Inst. 2014 Jun 12;106(7):dju116.\u003c/li\u003e\n\u003cli\u003eYan L, Chen Y, Chen F, Tao T, Hu Z, Wang J, You J, Wong BCY, Chen J, Ye W. Effect of Helicobacter pylori Eradication on Gastric Cancer Prevention: Updated Report From a Randomized Controlled Trial With 26.5 Years of Follow-up. Gastroenterology. 2022 Jul;163(1):154-162.e3.\u003c/li\u003e\n\u003cli\u003eLiou J-M, Malfertheiner P, Lee Y-C, et al. Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus. Gut 2020;69:2093\u0026ndash;112.\u003c/li\u003e\n\u003cli\u003eDing SZ. Global whole family based-Helicobacter pylori eradication strategy to prevent its related diseases and gastric cancer. World J Gastroenterol. 2020 Mar 14;26(10):995-1004.\u003c/li\u003e\n\u003cli\u003eEl-Omar EM, Oien K, Murray LS, El-Nujumi A, Wirz A, Gillen D, Williams C, Fullarton G, McColl KE. Increased prevalence of precancerous changes in relatives of gastric cancer patients: critical role of H. pylori. Gastroenterology. 2000 Jan;118(1):22-30.\u003c/li\u003e\n\u003cli\u003eZhao JB, Yuan L, Yu XC, Shao QQ, Ma J, Yu M, Wu Y, Qi YB, Hu RB, Wei PR, Jia BL, Zhang LZ, Zhang YR, Ding SZ. Whole family-based Helicobacter pylori eradication is a superior strategy to single-infected patient treatment approach: A systematic review and meta-analysis. Helicobacter. 2021 Jun;26(3):e12793.\u003c/li\u003e\n\u003cli\u003eDing S-Z, Du Y-Q, Lu H, et al. Chinese Consensus Report on Family-Based Helicobacter pylori Infection Control and Management (2021 Edition). Gut 2022;71:238\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003eWeyermann M, Rothenbacher D, Brenner H. Acquisition of Helicobacter pylori infection in early childhood: independent contributions of infected mothers, fathers, and siblings. Am J Gastroenterol 2009;104:182\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eNguyen BV, Nguyen KG, Phung CD, Kremp O, Kalach N, Dupont C, Raymond J, Vidal-Trecan G. Prevalence of and factors associated with Helicobacter pylori infection in children in the north of Vietnam. Am J Trop Med Hyg. 2006 Apr;74(4):536-9. \u003c/li\u003e\n\u003cli\u003eBrenner H, Bode G, Boeing H. Helicobacter pylori infection among offspring of patients with stomach cancer. Gastroenterology 2000;118:31\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eGasbarrini G, Pretolani S, Bonvicini F, Gatto MR, Tonelli E, M\u0026eacute;graud F, Mayo K, Ghironzi G, Giulianelli G, Grassi M. A population based study of Helicobacter pylori infection in a European country: the San Marino Study. Relations with gastrointestinal diseases. Gut. 1995 Jun;36(6):838-44. \u003c/li\u003e\n\u003cli\u003eOsaki T, Konno M, Yonezawa H, Hojo F, Zaman C, Takahashi M, Fujiwara S, Kamiya S. Analysis of intra-familial transmission of Helicobacter pylori in Japanese families. J Med Microbiol. 2015;64:67\u0026ndash;73.\u003c/li\u003e\n\u003cli\u003eKivi M, Tindberg Y, S\u0026ouml;rberg M, Casswall TH, Befrits R, Hellstr\u0026ouml;m PM, Bengtsson C, Engstrand L, Granstr\u0026ouml;m M. Concordance of Helicobacter pylori strains within families. J Clin Microbiol. 2003;41:5604\u0026ndash;5608. \u003c/li\u003e\n\u003cli\u003eDing SZ, Goldberg JB, Hatakeyama M. Helicobacter pylori infection, oncogenic pathways and epigenetic mechanisms in gastric carcinogenesis. Future Oncol. 2010;6:851\u0026ndash;862.\u003c/li\u003e\n\u003cli\u003eMatos JI, de Sousa HA, Marcos-Pinto R, Dinis-Ribeiro M. Helicobacter pylori CagA and VacA genotypes and gastric phenotype: a meta-analysis. Eur J Gastroenterol Hepatol. 2013;25:1431\u0026ndash;1441.\u003c/li\u003e\n\u003cli\u003eYu XC, Shao QQ, Ma J, Yu M, Zhang C, Lei L, Zhou Y, Chen WC, Zhang W, Fang XH, Zhu YZ, Wu G, Wang XM, Han SY, Sun PC, Ding SZ. Family-based Helicobacter pylori infection status and transmission pattern in central China, and its clinical implications for related disease prevention. World J Gastroenterol. 2022 Jul 28;28(28):3706-3719. \u003c/li\u003e\n\u003cli\u003eWang XM, Yee KC, Hazeki-Taylor N, Li J, Fu HY, Huang ML, Zhang GY. Oral Helicobacter pylori, its relationship to successful eradication of gastric H. pylori and saliva culture confirmation. J Physiol Pharmacol. 2014 Aug;65(4):559-66. \u003c/li\u003e\n\u003cli\u003eLeung WK, Sung JJ, Ling TK, Siu KL, Cheng AF. Use of chopsticks for eating and Helicobacter pylori infection. Dig Dis Sci. 1999 Jun;44(6):1173-6.\u003c/li\u003e\n\u003cli\u003eGisbert JP, Arata IG, Boixeda D, Barba M, Cant\u0026oacute;n R, Plaza AG, Pajares JM. Role of partner\u0026apos;s infection in reinfection after Helicobacter pylori eradication. Eur J Gastroenterol Hepatol. 2002 Aug;14(8):865-71.\u003c/li\u003e\n\u003cli\u003eSingh V, Trikha B, Vaiphei K, Nain CK, Thennarasu K, Singh K. Helicobacter pylori: evidence for spouse-to-spouse transmission. J Gastroenterol Hepatol. 1999 Jun;14(6):519-22.\u003c/li\u003e\n\u003cli\u003eLi M, Sun Y, Yang J, de Martel C, Charvat H, Clifford GM, Vaccarella S, Wang L. Time trends and other sources of variation in Helicobacter pylori infection in mainland China: A systematic review and meta-analysis. Helicobacter. 2020 Oct;25(5):e12729.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Demographic Characteristics of Enrolled Households and Risk Factors for \u003cem\u003eHelicobacter pylori\u0026nbsp;\u003c/em\u003eInfection\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"867\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartially Infected\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=84\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll Members Infected\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=37\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eAnnual household income (thousand yuan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e\u0026lt;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e44 (52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e30 (81.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e100-300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e30 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e5 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.24 (0.09-0.70, )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e0.26 (0.08-0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e\u0026gt;300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e10 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e2 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.29 (0.06-1.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e0.27 (0.05-1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eResident location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eCity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e42 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e22 (59.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eUrban\u0026minus;Rural Combined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e17 (20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e10 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e1.12 (0.44-2.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e25 (29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e5 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.38 (0.13-1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eHousehold living area (m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e\u0026lt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e8 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e2 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e60-120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e34 (40.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e23 (62.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e2.71 (0.53-13.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e＞120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e42 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e12 (32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e1.14 (0.21-6.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.876\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003ePets in household\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e68 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e27 (73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e16 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e10 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e1.57 (0.64-3.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eSources of drinking water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eBoiled water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e65 (77.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e30 (81.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eRaw water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e3 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e1 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.72 (0.07-7.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eBottled water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e2 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e1 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e1.08 (0.09-12.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003ePurified water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e14 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e5 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.77 (0.26-2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eDish washing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eTap water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e76 (90.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e33 (89.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eIn a basin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e8 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e4 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e1.15 (0.32-4.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eTableware sterilisation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eNo sterilisation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e56 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e25 (67.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eDisinfection cabinet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e19 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e10 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e1.18 (0.48-2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eOther disinfection methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e9 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e2 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.50 (0.10-2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eShared household items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eChopsticks and spoons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e75 (89.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e33 (89.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eWater cup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e5 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e2 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.91 (0.17-4.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eDental mouthwash cup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e4 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e2 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e1.14 (0.20-6.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eDish sharing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e4 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e4 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e80 (95.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e33 (89.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.41 (0.10-1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eServing chopsticks and spoons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e14 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e10 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e70 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e27 (73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.54 (0.21-1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003eFamily size (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e7 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e14 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e43 (51.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e11 (29.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.13 (0.04-0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e0.13 (0.04-0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e25 (29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e10 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.20 (0.06-0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e0.23 (0.07-0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e4 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e1 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.12 (0.01-1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e0.24 (0.02-2.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e4 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e1 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.13 (0.01-1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e0.17 (0.01-2.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14.4342%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.1663%;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.358%;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.8614%;\"\u003e\n \u003cp\u003e0.00 (0.00-Inf)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.96767%;\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.8222%;\"\u003e\n \u003cp\u003e0.00 (0.00-Inf )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.3903%;\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2 Demographic information of enrolled individuals and Helicobacter pylori infection risk factors\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"868\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUninfected\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfected\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e72 (43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e131 (51.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e95 (56.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e123 (48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e0.71 (0.48-1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eAge (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e47.8 \u0026plusmn; 14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e56.2 \u0026plusmn; 14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e1.04 (1.02-1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e1.05 (1.03-1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e10 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e13 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e157 (94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e241 (94.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e1.18 (0.51-2.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eWorker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e47 (28.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e60 (23.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e12 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e41 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e2.68 (1.27-5.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e3.36 (1.23-9.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eTeacher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e10 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e7 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e0.55 (0.19-1.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e1.10 (0.25-4.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e0.898\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eManagement/technical personnel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e30 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e23 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e0.60 (0.31-1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e0.87 (0.31-2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e5 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e6 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e0.94 (0.27-3.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e1.60 (0.28-8.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e2 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e1.57 (0.14-17.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e13.61 (0.36-512.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eFreelancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e62 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e115 (45.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e1.45 (0.89-2.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e2.05 (1.03-4.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.040\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eCompulsory education stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e70 (41.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e149 (58.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e94 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e88 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e0.44 (0.29-0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e1.11 (0.55-2.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e0.779\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e17 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e2.66 (0.76-9.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e1.07 (0.20-5.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e0.940\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eDrinking tap water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e13 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e23 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e154 (92.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e231 (90.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e0.85 (0.42-1.72, p=.649)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eWashing hands before meal and after defecation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e157 (94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e234 (92.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e10 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e20 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e1.34 (0.61-2.94, p=.463)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eDining at road side restaurant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eRare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e92 (55.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e151 (59.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e75 (44.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e103 (40.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e0.84 (0.56-1.24, p=.376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eNo. of infected family members exposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e112 (67.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e47 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e44 (26.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e86 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e4.66 (2.83-7.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e5.89 (3.16-10.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e6 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e51 (20.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e20.26 (8.14-50.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e53.77 (17.99-160.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e43 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e51.23 (11.92-220.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e149.84 (29.87-751.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e15 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e17.87 (3.93-81.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e35.68 (6.58-193.32, p\u0026lt;.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e12 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e28.60 (3.61-226.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e46.11 (4.16-510.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eGastrointestinal symptoms within last 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e133 (79.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e111 (43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e34 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e143 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e5.04 (3.21-7.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e4.85 (2.68-8.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003eHousehold residence duration\u003c/p\u003e\n \u003cp\u003e（years）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e7 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e5 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026ge;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e12 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e8 (3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e0.93 (0.22-4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026ge;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e61 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e44 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e1.01 (0.30-3.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e\u0026ge;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0184%;\"\u003e\n \u003cp\u003e87 (52.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6359%;\"\u003e\n \u003cp\u003e197 (77.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.1521%;\"\u003e\n \u003cp\u003e3.17 (0.98-10.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5991%;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.48848%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-gastrointestinal-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijgc","sideBox":"Learn more about [Journal of Gastrointestinal Cancer](https://www.springer.com/journal/12029)","snPcode":"12029","submissionUrl":"https://submission.nature.com/new-submission/12029/3","title":"Journal of Gastrointestinal Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Helicobacter pylori, Early gastric cancer, Infection patterns, Transmission","lastPublishedDoi":"10.21203/rs.3.rs-6897943/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6897943/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eBackground\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe prevention and control strategies for Helicobacter pylori \u003cem\u003e(H. pylori)\u003c/em\u003e are gradually shifting from individual-based care to family-based management approaches. However, the infection status, risk factors, and transmission dynamics of H. pylori within families of early gastric cancer (EGC) patients remain to be elucidated.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThis family-based study was conducted at Nanjing Drum Tower Hospital from June to December 2024, targeting cohabiting fam1ily members of EGC patients. Inclusion criteria required family members to have lived together for at least 10 months per year, with a minimum of two members and no upper limit on household size. An infected household was defined as having at least one member testing positive for H. pylori. The study investigated household H. pylori infection status, associated risk factors, and transmission patterns.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eAmong the 125 enrolled households, 21 (16.8%) consisted of 2 members, 57 (45.6%) of 3 members, 36 (28.8%) of 4 members, 5 (4.0%) of 5 members, 5 (4.0%) of 6 members, and 1 (0.8%) of 7 members. Of these households, 4 households (3.2%) showed no infections, 84 households (67.2%) had partial infections, and 37 households (29.6%) had full-family infections. Among the households, 79 (55.8%) included one couple, 34 (27.2%) included two couples, and 2 (1.6%) included three couples, while 10 households (8.0%) included only a husband or wife. In 153 couples, 67 couples (43.8%) had both partners infected, 22 couples (14.4%) had neither partner infected, and in the remaining couples, only one partner was infected. At the household level, higher annual household income was associated with a lower risk of infection (OR\u0026thinsp;=\u0026thinsp;0.26, 95% CI: 0.08\u0026ndash;0.80, p\u0026thinsp;=\u0026thinsp;0.019). At the individual level, older age, occupations such as farming or freelancing, exposure to infected household members, and a history of gastrointestinal discomfort were significant risk factors for infection (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). At the spousal level, infection rates increased with the duration of cohabitation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe infection rate in families of EGC patients was higher than in the general population, and EGC patients are likely the primary source of transmission within these households. Monitoring and eradicating Helicobacter pylori infection in family members of patients with early gastric cancer is very important for preventing and controlling the occurrence of gastric cancer.\u003c/p\u003e","manuscriptTitle":"Infection Characteristics and Transmission Patterns of Helicobacter pylori in Families of Early Gastric Cancer Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-25 02:36:40","doi":"10.21203/rs.3.rs-6897943/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-27T10:51:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-25T12:55:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-25T09:17:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68824289900249493564763875475701971089","date":"2025-06-21T18:13:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13243046925586588404681849656259186338","date":"2025-06-21T13:06:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-20T12:31:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-20T12:27:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-16T07:26:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Gastrointestinal Cancer","date":"2025-06-15T10:55:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-gastrointestinal-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijgc","sideBox":"Learn more about [Journal of Gastrointestinal Cancer](https://www.springer.com/journal/12029)","snPcode":"12029","submissionUrl":"https://submission.nature.com/new-submission/12029/3","title":"Journal of Gastrointestinal Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"691d0739-8e4c-4bac-a03c-d69c08500127","owner":[],"postedDate":"June 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-12T01:08:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-25 02:36:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6897943","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6897943","identity":"rs-6897943","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}