Epidemiological Status of Family-Based Helicobacter pylori Infection in Yunnan Province, China

Epidemiological Status of Family-Based Helicobacter pylori Infection in Yunnan Province, China | 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 Research Article Epidemiological Status of Family-Based Helicobacter pylori Infection in Yunnan Province, China Ying Wan, Yongmei Wu, Yunran Yang, Qingqing Zhou, Yu Li, Da Wang, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5466692/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Apr, 2025 Read the published version in BMC Gastroenterology → Version 1 posted 6 You are reading this latest preprint version Abstract Background The status of family-based H. pylori infection in Yunnan Province is unknown. This study is the first family-based epidemiological survey of H. pylori in the province, aiming to provide new insights into the status of family-based H. pylori infections in Yunnan Province as well as in the country as a whole. Methods Between 2021 and 2023, 1,176 families with 2,947 family members were tested for H. pylori in six cities in Yunnan Province with different geographic locations and economic status, to assess the status of H. pylori infection, and to clarify the related factors and modes of transmission by means of a questionnaire survey. Results In Yunnan Province, the H. pylori infection rate was 31.46% (927/2947) in people and 54.59% (642/1176) in families.On the individual side, living outside of southern Yunnan (eg, Central OR 1.41, 95% CI 1.10–1.81), having a family member living together for ≥ 1 year (OR 2.43, 95% CI 1.49–3.95), being ≥ 18 years old (eg, 18–44 years old: OR 3.51, 95% CI 1.98–6.23), and gastrointestinal discomfort within the last 1 year (OR 1.25, 95% CI 1.04–1.50) were independent risk factors for H. pylori infection in the study population in Yunnan Province, whereas an education level of college/university and above (OR 0.62, 95% CI 0.48–0.79), and a gastroscopy within 5 years (OR 0.58, 95% CI 0.46–0.73) were independent protective factors for their H. pylori infection. In terms of family, living outside of southern Yunnan (eg, Central OR 1.52, 95% CI 1.07–2.18), and having ≥ 3 people living together in the family (eg, 3–4 people: OR 2.04, 95% CI 1.52–2.72) were independent risk factors for H. pylori infection in study families in Yunnan Province, whereas an annual household income of ≥ 100,000 ( OR 0.68, 95% CI 0.51–0.90), total household living area ≥ 60 m2 (OR 0.62, 95% CI 0.39–0.97), the use of separate meals for intra-household gatherings (OR 0.56, 95% CI 0.38–0.85), and the use of communal spoons and chopsticks (OR 0.38, 95% CI 0.28–0.52) were the independent protective factorse. Conclusion The risk factors of Family-Based H. pylori infection in Yunnan province were closely related to demographic characteristics, personal and family living habits. Close contact with infected family members may be the main cause of transmission. Family-based control of H. pylori infection should be regarded in clinical practice. Helicobacter pylori Family-based Epidemiological Ethnic minority Risk factors Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction H. Pylori is a gram-negative pathogenic bacterium that is specifically localised to the gastric epithelium,In the 1980s, Drs. Marshall and Warren discovered the bacteria through ongoing research [ 1 ] .Since then, research has consistently confirmed that H. pylori chronic infection not only can lead to gastrointestinal diseases such as chronic gastritis, peptic ulcer,intestinal metaplasia, gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue lymphoma [ 2 ] , but also is closely associated with a number of extra-gastrointestinal diseases [ 3 , 4 ] . H. pylori infection is a major risk factor for the development of gastric cancer [ 5 ] , and among the cancers caused by various pathogens, gastric cancer caused by H. pylori infection is the first one, surpassing liver cancer caused by hepatitis viruses and cervical cancer caused by human papillomaviruses [ 6 ] . In 1994, the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) defined H. pylori as a class I carcinogen [ 7 ] , and so far, H. pylori is the only bacterium with this risk level. It is clear that H. pylori infection-associated diseases are a health threat to families and society. All H. pylori infections should be considered pathogenic and should be eradicated [ 8 ] . H. pylori infection is an infectious disease that can be transmitted from person to person, especially among family members [ 9 , 10 ] . The latest studies show that the rate of H. pylori infection in households in China ranges from 50.27–85.06%, with an average infection rate of 71.21%, and the rate of H. pylori infection among individuals in China ranges from 25.33–59.61%, with an average rate of 40.66%,both show regional variability [ 10 ] . Yunnan Province is located in the border area, where ethnic minorities live, and has unique dietary and living habits. In recent years, because of the favourable climate, more and more families have chosen to visit or even settle in Yunnan, and the health and hygiene conditions in Yunnan are getting more and more attention. There has not been any epidemiological survey of H. pylori in Yunnan Province based on households, and the status of household H. pylori infections, related factors, and modes of transmission have not yet been evaluated. Therefore, in the face of such a severe situation of H. pylori infection prevention and treatment, it is important to understand the current situation of H. pylori infection in households in Yunnan Province, which is of great significance for the prevention and treatment of H. pylori in the province. Materials and methods Study population According to the formula: n = z 2 p(1-p)/d 2 (n, z, p, and d are sample size, z value, positive rate, and acceptable error, respectively), the sample size was calculated, and the prevalence rate of households was about 50%, the test level was 0.05, the confidence level was 0.95, and the permissible error was 3%, and we found out that the Z value was 1.96 by consulting the table of the standard normal distribution, and a total of 1,067 households needed to be included.Considering the additional bias of the convenience sampling method, we finally included 1176 households.The study was conducted from August 2021 to November 2023 in six prefectures of Yunnan Province, including Kunming, Baoshan, Lincang, Qujing, Xishuangbanna Dai Autonomous Prefecture, and Honghe Hani and Yi Autonomous Prefecture(Fig. 1 ), in which 1,176 families and 2,947 eligible volunteers were randomly selected and enrolled in this study. The screening and registration process in each prefecture was carried out by postgraduate students from the Department of Gastroenterology at the First Affiliated Hospital of Kunming Medical University, medical staff from local tertiary hospitals, and trained volunteers.Households with ≥ 2 household members (living continuously for more than 10 months per year) were invited to participate in the survey. Families were excluded from the study if they had a family member who had taken antibiotics, bismuth, or proton pump inhibitors within 4 weeks, a history of major gastric resection, active bleeding from the upper gastrointestinal tract within 1 week, and women who were preparing for pregnancy, were pregnant, or were breastfeeding.Households with ≥ 1 household member infected with H. pylori are recognised as positive households.The study was approved by the Ethics Committee of the First Affiliated Hospital of Kunming Medical University(No. 148, 2022), and all enrolled participants or their guardians complied with the voluntary principle and signed the relevant informed consent forms. Questionnaire All participating family members or their guardians filled out a questionnaire [ 10 ] . The questionnaire mainly included demographic characteristics (e.g., gender, age, occupation, etc.), socio-economic situation (e.g., annual household income and education level, etc.), personal and family living habits (e.g., hand hygiene, family dietary habits, etc.), and past medical history. The questionnaires were completed both electronically and on paper, and specially trained enumerators administered the questionnaires on-site to all participants or their guardians on a one-to-one basis, carefully collecting data and excluding invalid questionnaires. Helicobacter pylori test In this study, H. pylori testing was performed on all included members according to the instructions of the HUBT-20A H. pylori detector and urea [14C] breath test kit (Shenzhen Zhongguo Haidui Biotechnology Co., Ltd.), and the HY-IREXB Carbon 13 Breathalyzer and Urea [13C] Breath Test Diagnostic Kit (Beijing Huagananbang Science and Technology Co., Ltd.).The sensitivity and specificity of the two tests were similar and both had high accuracy. Statistical analysis Statistical analyses were performed using SPSS 25.0 software. Continuous variables were expressed as mean ± standard deviation, and categorical variables were expressed as numbers and percentages. Continuous variables were compared using the t-test or Fisher's exact probability method, and categorical variables were compared using the chi-square test. Risk factor analyses were performed using multifactor logistic regression modelling, and all variables were included in the model(stepwise, sls = 0.10,sle = 0.05). Contrast ratios (OR) and 95% confidence intervals (CI) were calculated, and differences were considered statistically significant at P < 0.05. Result H. pylori infection status of individuals A total of 2947 subjects were examined, 927 were H. pylori -positive and 2020 were H. pylori -negative, giving an overall infection rate of 31.46%.Among them, the infection rate of minors(less than 18 years old) was 11.54% (15/130), and the infection rate of adults was 32.37% (912/2817), with statistically significant differences in the H. pylori infection rates of individuals of different ages (P < 0.05), showing a trend of increasing with age(Fig. 2 ). The infection rate of the southern region of Yunnan was the lowest at 21.24% (100/467), and that of the western region of Yunnan was the The highest 46.10% (248/538), the difference of H. pylori infection rate among individuals in different geographical locations was statistically significant (P < 0.05)(Fig. 4 A). In univariate analysis, the risk of H. pylori infection was higher among those who lived outside of southern Yunnan, had family members living together for ≥ 1 year, were adults, and were married (P < 0.05). In contrast, the risk of H. pylori infection was lower among those with education level of college or above, occupation other than farmer, frequent eating out, gastroscopy within 5 years, and previous H. pylori examination (P < 0.05) (Table 1 ). Multifactorial logistic regression analysis showed that, on the individual side, living outside of southern Yunnan (eg, Central OR 1.41, 95% CI 1.10–1.81), having a family member living together for ≥ 1 year (OR 2.43, 95% CI 1.49–3.95), being ≥ 18 years old (eg, 18–44 years old: OR 3.51, 95% CI 1.98–6.23), and gastrointestinal discomfort within the last 1 year (OR 1.25, 95% CI 1.04–1.50) were independent risk factors for H. pylori infection in the study population in Yunnan Province, whereas an education level of college/university and above (OR 0.62, 95% CI 0.48–0.79), and a gastroscopy within 5 years (OR 0.58, 95% CI 0.46–0.73) were independent protective factors for their H. pylori infection (Table 1 ). Table 1 General personal information and risk factors for H. pylori infection Categories N(%) Positive for H. pylori , N(%) Negative for H. pylori , N(%) Univariate analysis Multivariable analysis OR(95%CI) P value OR(95%CI) P value Geographical areas South 467(15.85) 100(21.41) 367(78.59) Reference Reference Central 1816(61.62) 523(28.80) 1293(71.20) 1.48(1.16–1.89) 0.001 1.41(1.10–1.81) 0.007 Northeast 126(4.28) 56(44.44) 70(55.56) 2.94(1.94–4.45) <0.001 3.75(2.43–5.77) <0.001 West 538(18.26) 248(46.10) 290(53.90) 3.14(2.38–4.15) <0.001 3.12(2.35–4.15) <0.001 The time living together <1 year 133(4.51) 21(15.79) 112(84.21) Reference ≥ 1 year 2814(95.49) 906(32.20) 1908(67.80) 2.53(1.58–4.06) <0.001 2.43(1.49–3.95) <0.001 Gender Male 1173(39.80) 363(30.95) 810(69.05) Reference Female 1774(60.20) 564(31.79) 1210(68.21) 1.04(0.89–1.22) 0.628 Age <18 years 130(4.41) 15(11.54) 115(88.46) Reference Reference 18–44 years 1013(34.37) 266(26.26) 747(73.74) 2.73(1.57–4.76) <0.001 3.51(1.98–6.23) <0.001 45–59 years 1114(37.80) 389(34.92) 725(65.08) 4.11(2.37–7.14) <0.001 4.60(2.62–8.05) <0.001 ≥ 60 years 690(23.41) 257(37.25) 433(62.75) 4.55(2.60–7.96) <0.001 5.00(2.83–8.83) <0.001 Ethnicity Han 2256(76.55) 712(31.56) 1544(68.44) Reference Minority 691(23.45) 215(31.11) 476(68.89) 0.98(0.82–1.18) 0.825 Resident location Town 1114(37.80) 336(30.16) 778(69.84) Reference Rural 1833(62.20) 591(32.24) 1242(67.76) 1.10(0.94–1.29) 0.238 Marital status Single 425(14.42) 82(19.29) 343(80.71) Reference Married 2522(85.58) 845(33.51) 1677(66.49) 2.11(1.63–2.72) <0.001 Education level Primary school or lower 818(27.76) 300(36.67) 518(63.33) Reference Reference Middle/high school 1182(40.11) 386(32.66) 796(67.34) 0.84(0.69–1.01) 0.063 0.91(0.75–1.12) 0.370 College and above 947(32.13) 241(25.45) 706(74.55) 0.59(0.48–0.72) <0.001 0.62(0.48–0.79) <0.001 Occupation Farmer 1069(36.27) 389(36.39) 680(63.61) Reference Non-farmer 983(33.36) 291(29.60) 692(70.40) 0.74(0.61–0.89) 0.001 Student 216(7.33) 32(14.81) 184(85.19) 0.30(0.21–0.45) <0.001 Unemployed/retired 679(23.04) 215(31.66) 464(68.34) 0.81(0.66–0.99) 0.043 Drink raw water No 2482(84.22) 765(30.82) 1717(69.18) Reference Yes 465(15.78) 162(34.84) 303(65.16) 1.20(0.97–1.48) 0.087 Washing hands before meal and after defecation No 295(10.01) 103(34.92) 192(65.08) Reference Yes 2652(89.99) 824(31.07) 1828(68.93) 0.84(0.65–1.08) 0.178 Frequency of eating out Rare 2379(80.73) 771(32.41) 1608(67.59) Reference More than two days per week 568(19.27) 156(27.46) 412(72.54) 0.79(0.64–0.97) 0.023 Gastrointestinal symptoms within last 1 year No 1990(67.53) 610(30.65) 1380(69.35) Reference Yes 957(32.47) 317(33.12) 640(66.88) 1.12(0.95–1.32) 0.176 1.25(1.04–1.50) 0.018 Gastroscopy within 5 years No 2402(81.51) 791(32.93) 1611(67.07) Reference Yes 545(18.49) 136(24.95) 409(75.05) 0.68(0.55–0.84) <0.001 0.58(0.46–0.73) <0.001 Previously tested for H. pylori No 2466(83.68) 804(32.60) 1662(67.40) Reference Yes 481(16.32) 123(25.57) 358(74.43) 0.71(0.57–0.89) 0.002 History of gastroduodenal surgery No 2908(98.68) 913(31.40) 1995(68.60) Reference Yes 39(1.32) 14(35.90) 25(64.10) 1.22(0.63–2.37) 0.548 H. pylori infection status of Household A total of 1176 households were included in this study, and the results showed that there were 642 H. pylori -positive households and 534 H. pylori -negative households, with a total household infection rate of 54.59%. Of the 1176 households, 45.41% (534/1176) had no member infected, 35.54% (418/1176) had one member infected and 11.14% (131/1176) had all members infected.The lowest infection rate was 43.02% (77/179) in southern Yunnan, and the highest rate was 69.50% (139/200) in western Yunnan, with statistically significant differences in the rate of H. pylori infection in households in different geographic locations (P < 0.05)(Fig. 4 B). Household infection rates increase with the number of family members(Fig. 3 ). In univariate analysis, the risk of H. pylori infection was higher (P 2 persons living together in the household, and drinking heated tap water. In contrast, the risk of H. pylori infection was lower (P < 0.05) in households with an annual household income ≥ 100,000, a total household living area ≥ 60 m², a split meal system for family meals, and the use of communal chopsticks and spoons for family mealse (Table 2 ). Multifactorial logistic regression analysis showed that, in terms of family, living outside of southern Yunnan (eg, Central OR 1.52, 95% CI 1.07–2.18), and having ≥ 3 people living together in the family (eg, 3–4 people: OR 2.04, 95% CI 1.52–2.72) were independent risk factors for H. pylori infection in study families in Yunnan Province, whereas an annual household income of ≥ 100,000 ( OR 0.68, 95% CI 0.51–0.90), total household living area ≥ 60 m2 (OR 0.62, 95% CI 0.39–0.97), the use of separate meals for intra-household gatherings (OR 0.56, 95% CI 0.38–0.85), and the use of communal spoons and chopsticks (OR 0.38, 95% CI 0.28–0.52) were the independent protective factorse (Table 2 ). Table 2 General family information and risk factors for H. pylori infection Categories N(%) Positive for H. pylori , N(%) Negative for H. pylori , N(%) Univariate analysis Multivariable analysis OR(95%CI) P value OR(95%CI) P value Geographical areas South 179(15.22) 77(43.02) 102(56.98) Reference Reference Central 741(63.01) 388(52.36) 353(47.64) 1.46(1.05–2.02) 0.025 1.52(1.07–2.18) 0.021 Northeast 56(4.76) 38(67.86) 18(32.14) 2.80(1.48–5.27) 0.001 2.77(1.41–5.43) 0.003 West 200(17.01) 139(69.50) 61(30.50) 3.02(1.98–4.60) <0.001 3.34(2.12–5.26) <0.001 Family size(n) 2 802(68.20) 393(49.00) 409(51.00) Reference Reference 3–4 324(27.55) 207(63.89) 117(36.11) 1.84(1.41–2.40) <0.001 2.04(1.52–2.72) <0.001 ≥ 5 50(4.25) 42(84.00) 8(16.00) 5.46(2.53–11.78) <0.001 6.86(3.06–15.36) <0.001 Resident location Town 415(35.29) 219(52.77) 196(47.23) Reference Rural 761(64.71) 423(55.58) 338(44.42) 1.12(0.88–1.42) 0.354 Annual incomee (yuan) <100,000 856(72.79) 483(56.43) 373(43.57) Reference ≥ 100,000 320(27.21) 159(49.69) 161(50.31) 0.76(0.59–0.99) 0.039 0.68(0.51–0.90) 0.007 Household living area(㎡) <60 108(9.18) 69(63.89) 39(36.11) Reference ≥ 60 1068(90.82) 573(53.65) 495(46.35) 0.65(0.43–0.99) 0.043 0.62(0.39–0.97) 0.036 Animals in household No 890(75.68) 477(53.60) 413(46.40) Reference Yes 286(24.32) 165(57.69) 121(42.31) 1.18(0.90–1.55) 0.226 Sources of drinking water Bottled water 619(52.64) 317(51.21) 302(48.79) Reference Tap water(heated) 474(40.31) 274(57.81) 200(42.19) 1.31(1.03–1.66) 0.030 Other 83(7.06) 51(61.45) 32(38.55) 1.52(0.95–2.43) 0.081 Dish washing Still water / basin wash 246(20.92) 138(56.10) 108(43.90) Reference Flow washing 930(79.08) 504(54.19) 426(45.81) 0.93(0.70–1.23) 0.594 Tableware sterilisation No 788(67.01) 442(56.09) 346(43.91) Reference Yes 388(32.99) 200(51.55) 188(48.45) 0.83(0.65–1.06) 0.141 Separate dining No 1024(87.07) 588(57.42) 436(42.58) Reference Yes 152(12.93) 54(35.53) 98(64.47) 0.41(0.29–0.58) <0.001 0.56(0.38–0.85) 0.006 Use communal chopsticks and spoons No 877(74.57) 538(61.35) 339(38.65) Reference Yes 299(25.43) 104(34.78) 195(65.22) 0.34(0.26–0.44) <0.001 0.38(0.28–0.52) <0.001 Family history of gastric cancer or peptic ulcers No 971(82.57) 522(53.76) 449(46.24) Reference Yes 205(17.43) 120(58.54) 85(41.46) 1.21(0.90–1.65) 0.212 Discussion H. pylori infects half of the world's population and is a major health threat to Chinese families and society. The traditional "Test and treat" and "Screen and treat" have long been the strategies for treating H. pylori infection [ 4 ] , however, in recent years, with the advancement of clinical practice and public awareness, H. pylori infection in the family has been more widely noticed, and more and more studies and guidelines have pointed out that H. pylori can be transmitted between people, especially among family members, and that H. pylori infection has an obvious family aggregation [ 4 , 9 ] . Therefore, preventing and controlling infections among family members is a practical way to block the chain of transmission and reduce the rate of infection in society. Starting from the new important strategy of "family-based H. pylori infection control and management" [ 11 ] , Yunnan Province conducted the first family-based H. pylori epidemiological survey in the province, which provided a new understanding of the status of family-based H. pylori infections in Yunnan Province as well as in the whole country. The results of this study showed that the H. pylori infection rate in Yunnan Province was 31.46% (927/2947) in individuals and 54.59% (642/1176) in families, with more than half of the families infected with H. pylori , and the rate of H. pylori infection in families was significantly higher than that in individuals, which is in line with previous studies [ 12 ] . In terms of the regional distribution of infections, there were significant differences in the prevalence of H. pylori infections among the four different geographic locations, namely, southern Yunnan, central Yunnan, northeastern Yunnan, and western Yunnan, both in terms of individuals and families.It can be seen that there are regional differences in H. pylori infections, which can be caused by a variety of factors such as socio-economic conditions, cultural customs, and living and dietary habits, etc. Therefore, it is very important that prevention, control, and treatment strategies be tailored to the needs of the local context, and, of course, the artificial interventions adopted in the prevention and control of H. pylori infections in different countries and regions are very important. Of course, the human intervention in the prevention and control of H. pylori infection in different countries and regions is also an influencing factor of the local epidemiological trend.However, there was no significant difference in the prevalence of H. pylori infections between different regions in Hainan Province [ 9 ] . In terms of changes in infection rates, a continued decline in H. pylori infection rates has been reported in many parts of the world, including South Korea [ 13 , 14 ] , China [ 15 ] , Austria [ 16 ] , Iran [ 17 ] , and Malaysia [ 18 ] .Meta-analyses in recent years have shown that the global H. pylori infection rate has declined from 58.2% during the period 1980–1990 to 43.1% during the period 2011–2022 [ 19 ] , and that the H. pylori infection rate in our country has declined by 0.9% per year during the period 1983–2018, from 63.8% in 1983–1994 to 2006–2018 as 46.7% [ 20 ] . A Japanese study predicts a further decline in H. pylori prevalence by 2050 [ 21 ] .The continuous decline in infection rates at home and abroad is related to improvements in education, the economy, and sanitation, as well as increasing public health awareness. In recent years, H. pylori health education has been continuously carried out in our province to standardise the diagnosis and treatment of H. pylori , and has been improved in clinical practice. In this study, the overall personal infection rate (31.46%) and the personal infection rate (21.41%) in the southern Yunnan region of our province were lower than the survey data of Wang Lan in 2018, 45.29% and 43.01%,and the personal infection rate (28.8%) in the central Yunnan region was also lower than the survey data of Jia Demei et al. in 2013–2015, 33.5%; in addition, the household infection rate, In addition, the household infection rate (54.59%) and individual infection rate (31.46%) are lower than the national household infection rate (71.21%) and individual infection rate (40.66%) in 2022, which shows that the prevention and treatment effect is remarkable. Yunnan Province is located in the southwestern border of China, dominated by mountains and plateaus, with great terrain undulations, obvious climatic differences in different places, and the concentration of ethnic minorities in the territory, creating unique dietary habits and living conditions in different places. In this study, the H. pylori infection rate of families and people in southern Yunnan, such as Xishuangbanna and Honghe, was significantly lower than that of people in central Yunnan, northeastern Yunnan, and western Yunnan (P < 0.001), which may be related to the fact that people in southern Yunnan like to eat spicy and stimulating foods, and pepper oil, chilli pepper, and garlic are added to their dipping sauces, which were found to have an antimicrobial or bacteriostatic effect on Helicobacter pylori in the stomach in previous studies [ 22 – 25 ] . H. pylori is mainly transmitted within the family through the oral-oral, faecal-oral, and shared utensil routes and is difficult to self-clean after infection [ 11 ] .Longer time of family members living together means that the exposure time and frequency of certain risk factors increase, leading to the formation of oral-oral or faecal-oral chain of transmission of H. pylori within the family through some medium, which results in infections.National studies have shown that when couples cohabit from 5 years to 30 years, the The prevalence of infection increased from 17–22%-24% [ 10 ] , and in this study it was also shown that the prevalence of H. pylori infection was 2.43 times higher in those whose family members had been living together for ≥ 1 year than in those who had been living together for < 1 year (p < 0.001), which in some sense proves the clustering of infection in the family. Regarding the relationship between age and H. pylori infection, different studies have different views. Alarid-Escudero et al. [ 26 ] conducted a mathematical model to assess the potential risk of H. pylori infection in Mexico, and this model estimated that H. pylori infection force is highest at birth and decreases to zero with age.In this study, the H. pylori infection rate increased with age, and the old age group (≥ 60 years old) had the highest infection rate, which is consistent with the study of Danni Liu et al. [ 9 ] in Hainan, and the H. pylori infection rate of the middle-aged group (45–59 years old) and the old age group (≥ 60 years old) exceeded the average infection rate of Yunan Province, which is a priority for the prevention and control of H. pylori infection in these two age groups. The relationship between H. pylori infection and ethnicity has been reported differently in different studies. The ethnic structure of Malaysia consists of three main Asian races including Malays, Chinese and Indians. Indians had the highest prevalence of H. pylori infection (> 50%), followed by Chinese (40%-50%), while Malays had a relatively low prevalence of about 10%-20% [ 18 ] , suggesting that H. pylori spreads predominantly within ethnicity. In contrast, there was no significant difference in the prevalence of H. pylori infection between the Han nationality and ethnic minority populations in the study in Hainan Province [ 9 ] , which is consistent with this study. The residence status of all ethnic groups in China is "big mixed residence, small settlement", and this form of distribution is conducive to the interaction of all ethnic groups, and the free intermarriage between different ethnic groups may make the influence of host genetic factors and the distribution of strains among ethnic groups less and less. Higher educated people have good hygiene and dietary habits, and have higher acceptance and compliance to health education information, and this study shows that higher educated people have lower H. pylori infection rate, which is consistent with related research reports [ 10 , 27 ] . Traditionally, many people believe that eating out is a hygiene hazard and that it is easy to "spread disease from mouth to mouth". Previous studies have shown that people who eat out more frequently are at higher risk of H. pylori infection [ 10 ] . Interestingly, the results of this study showed that the risk of H. pylori infection was significantly lower in those who ate out more frequently (more than 2 days per week) than those who rarely ate out. People in Yunnan often use fermented foods for flavouring dishes, especially in the catering industry, such as tempeh and pickles, in which the probiotics may inhibit the growth of H. pylori . In recent years, with socio-economic development and greatly improved hygiene conditions, the catering industry has stricter hygiene standards, and the technology and frequency of disinfection of tableware even exceeds that of some families with low hygiene concepts. After the tableware has been sterilised and divided, the risk of infection is reduced. In addition, when eating out, separate meals and the use of communal chopsticks are more common, which reduces the chance of cross-infection brought about by sharing tableware. Dining out offers a wide variety of food choices, and the intake of vegetables and fruits is rich in antioxidants, which may help to suppress H. pylori. Moreover, people who eat out more often are usually better off and have access to better medical services and health protection. These factors above are not absolute and are subject to further research. H. pylori infected people present with varying degrees of gastrointestinal symptoms, and the prevalence of H. pylori infection was higher among people with gastrointestinal symptoms in the past 1 year in this study, so it is more important for symptomatic people to be screened for H. pylori in time to prevent further transmission and the development of related diseases. However, this was not found in previous studies. Currently, advanced endoscopic technology allows for a high degree of accuracy in the diagnosis of gastrointestinal lesions, and most gastroenterologists will ask patients to complete an H. pylori test if gastroscopy reveals a lesion, and will recommend eradication treatment if there is an infection with no contraindications to eradication, and if there is no infection, some patients will also undergo outpatient counselling or Internet consultation, which will increase their awareness of H. pylori , and then undergo H. pylori screening. In this study, the H. pylori infection rate was lower in those who had undergone gastroscopy within 5 years compared to those who had not, which was considered to be related to the above factors. With a large family size, the living environment is relatively crowded, with poor environmental hygiene, close contact between family members, and the superposition of risk factors, which provide favourable conditions for the spread of H. pylori within the family, and the present study found that families with a large number of people living together had a high rate of H. pylori infection, which is consistent with previous studies [ 10 ] . Annual household income and household living area represent the socio-economic status of a family. Families with high annual household income and large total living area also have relatively better family hygiene, living conditions, education level and working environment, and the risk of H. pylori infection is lower. Firstly, better-off families can afford better healthcare services, including H. pylori testing and treatment, which can reduce infection rates. Secondly, higher-income families usually have larger family living space, better living and hygienic conditions, such as better ventilation and lighting conditions, clean drinking water and food, clean kitchens and bathrooms, and regular cleaning of furnished environments, which can help to reduce bacterial growth and transmission. Lastly, people with a high level of education usually have a better sense of hygiene and are able to take effective preventive measures, such as washing hands frequently and using communal chopsticks, etc. They are also more inclined to undergo regular medical check-ups and seek timely medical treatment, which can help in early detection and treatment, thereby reducing the infection rate. All these factors tend to interact with each other. For example, people with a higher level of education usually have a higher income and are able to improve their living conditions, further reducing the infection rate. Our findings also confirm that households with higher socioeconomic levels have lower H. pylori infection rates, consistent with previous studies [ 28 – 30 ] . In addition to humans, some animals, such as cattle and sheep, may also be hosts for H. pylori [ 31 ] , although no correlation was found between having animals in the home and H. pylori in the home in this study. In Bogotá, Colombia, long-term sampling of water sources showed that H. pylori DNA was found in 31% and 38.7% of raw water and drinking water samples, respectively [ 32 ] . In Peru, the intake of unboiled water (93.9%) and watercress (79.6%) were found to be the most important factors associated with H. pylori infection in children [ 33 ] . In the United Arab Emirates, the prevalence of H. pylori was significantly higher among tap water drinkers than among bottled water drinkers [ 34 ] . In the present study, the risk of H. pylori infection was higher in households consuming heated tap water compared to those consuming bottled water. Therefore, untreated tap water should not be used as a source of drinking water in the home. The oral cavity is the first gateway for H. pylori to enter the human body, and many scholars have applied molecular biology and immunological methods to detect oral H. pylori in dental plaque, saliva, tongue, and dental pulp [ 35 – 38 ] , and H. pylori DNA has even been detected on chopsticks [ 39 ] .In Chinese families, the use of chopsticks to hold food when sharing a meal with family and friends has been a part of the Chinese culture for centuries, and the practice of mouth-to-mouth feeding of young children is a common phenomenon in families. The feeding of young children with mouth-to-mouth is a frequent occurrence in families, which inadvertently transmits pathogens through the oral component.Z. Ding et al. [ 40 ] found that eating alone was an independent protective factor against H. pylori infection.Using of communal chopsticks and spoons reduced the risk of H. pylori infection in the family [ 10 ] .In the present study, the low rate of H. pylori infection in families that used communal chopsticks and spoons and a split-meal diet is in line with previous studies, and provides evidence for the oral-oral route of transmission, and emphasises the importance of implementing home-based control and management of H. pylori infection in clinical practice. To raise public awareness of the prevention of H. pylori infection, good hygiene practices should be further promoted through community health activities, media campaigns, school education, etc., taking into account the local conditions. Because the sample size was large enough, the common method of performing univariate analyses was used and then all the variables were included in the multivariate model and stepwise regression was used for the control of variable inclusion. Also for categorical variables such as geographic location, education level, etc., they were converted to dummy variables to view the stratification effect, and age as a continuous variable was also grouped. Confounding factors in this study have been controlled as much as possible. There are some limitations to this study. First, the survey used a convenience sampling method, which may limit generalisations and bias the overall selection, but because of the large sample size, the impact was small. Second, the detection method used only the urea breath test, which can only represent a presenting infection and can be made more accurate by combining it with serological or faecal antigen testing. Third, this work was conducted in Yunnan Province and the definition of geographical areas is not precise in terms of latitude and longitude, the results may not be applicable to other regions. Fourth, The 50% prevalence assumption for sample size calculation lacks previous epidemiological surveys and may not reflect the true baseline rate. We acknowledge any bias in data collection or reporting. Conclusions The overall rate of H. pylori infection in Yunnan Province is lower than the national average, with variations by region.There is family aggregation of H. pylori infection, and the risk factors for infection are closely related to demographic and sociological characteristics, family characteristics, and individual and family living habits. Therefore, the prevention and control of H. pylori infection should be tailored to local conditions, and comprehensive measures should be developed on a family basis. Declarations Ethics approval and consent to participate This study was conducted in strict accordance with the Declaration of Helsinki.The study was approved by the Ethics Committee of the First Affiliated Hospital of Kunming Medical University, and all enrolled participants or their guardians complied with the voluntary principle and signed the relevant informed consent forms. Consent for publication Not applicable. Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Yunnan Leading Talent Programme(L-2019024), National Clinical Key Specialty Construction Project and Yunnan Province "High-level Talent Cultivation Support Program" Famous Doctor Special Project. Authors' contributions Lanqing Ma conceived and designed the study. Yunran Yang, Qingqing Zhou, Yu Li, Da Wang, Dan Zhang, Yule He, Hang Chen, Minshan Huang collected the data. Kunpeng Na and Lan Liu analyzed the data. Ying Wan wrote the article. Dingyun You, Le Cai, Yongmei Wu review the manuscript and give some advices.The manuscript was critically reviewed and approved by all authors. Acknowledgements The authors would like to thank all the leaders and team members of the participating hospitals(Listed in alphabetical order by last name). Dr Bai Jianping, Dr Xia Benlin, Dr Qian Chongxiang and Dr Wang Xin from the First People's Hospital of Honghe State; Dr Chen Lifang, Dr Luo Sufeng and Dr Feng Jingfang from The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture; Dr Ren Li, Dr Lv Minghua, Nurse Qiu Hongxing and Nurse Zhang E from Huize County People's Hospital; Dr Yang Taiming, Dr Liu Yan, Dr Yang ningling and Dr Yang Mengying from Lincang People's Hospital; Dr Zhang Hao and Dr Zao Chunhua from the Baoshan People's Hospital. 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Prevalence and risk factors of Helicobacter pylori infection in asymptomatic Chinese children: a prospective, cross-sectional, population-based study [J]. Aliment Pharmacol Ther, 2015, 42(8): 1019-1026. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Apr, 2025 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Accepted 20 Mar, 2025 Reviews received at journal 19 Mar, 2025 Reviewers agreed at journal 19 Mar, 2025 Reviewers invited by journal 19 Mar, 2025 Submission checks completed at journal 19 Mar, 2025 First submitted to journal 18 Mar, 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. 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15:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5466692/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5466692/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-025-03806-1","type":"published","date":"2025-04-29T15:56:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":78869975,"identity":"34c64f74-e299-4ead-b779-8dc6e795e3dc","added_by":"auto","created_at":"2025-03-20 05:38:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":201213,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Area Distribution in Yunnan Province\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5466692/v1/3be7865498022d4c638f98fe.png"},{"id":78869413,"identity":"19456a9e-52ab-4264-9735-2a0a9de6e084","added_by":"auto","created_at":"2025-03-20 05:30:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":50128,"visible":true,"origin":"","legend":"\u003cp\u003eHelicobacter pylori infection Status in patients of different ages\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5466692/v1/71fefa5e3d6766f21c1b847c.png"},{"id":78869974,"identity":"bd1f340c-16c4-413e-b705-c166e5d103a9","added_by":"auto","created_at":"2025-03-20 05:38:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":44105,"visible":true,"origin":"","legend":"\u003cp\u003eHelicobacter pylori infection Status in different family size\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5466692/v1/3c11474a64962dc069fb404a.png"},{"id":78869416,"identity":"58d5bacd-6187-4315-b560-c750bfb2b20b","added_by":"auto","created_at":"2025-03-20 05:30:24","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":56711,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eH. pylori\u003c/em\u003e infection status in different geographical locations. (A)Individual \u003cem\u003eH. pylori\u003c/em\u003e infection status in different geographical locations. **p\u0026lt;0.01, ***p\u0026lt;0.001 when infection rates between the two groups were compared;ns, not significant when these groups were compared with each other, p\u0026gt;0.05. (B)Household \u003cem\u003eH. pylori\u003c/em\u003e infection status in different geographical locations.**p\u0026lt;0.01, ***p\u0026lt;0.001 when infection rates between the two groups were compared;ns, not significant when these groups were compared with each other, p\u0026gt;0.05.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5466692/v1/a16bba95ecced7b685f78189.png"},{"id":81987403,"identity":"681b7449-2094-4717-9632-9746ce5d4518","added_by":"auto","created_at":"2025-05-05 16:00:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1916010,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5466692/v1/efacfd8d-10d0-4469-ac6b-321c3d72f05c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological Status of Family-Based Helicobacter pylori Infection in Yunnan Province, China","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cem\u003eH. Pylori\u003c/em\u003e is a gram-negative pathogenic bacterium that is specifically localised to the gastric epithelium,In the 1980s, Drs. Marshall and Warren discovered the bacteria through ongoing research\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.Since then, research has consistently confirmed that \u003cem\u003eH. pylori\u003c/em\u003e chronic infection not only can lead to gastrointestinal diseases such as chronic gastritis, peptic ulcer,intestinal metaplasia, gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue lymphoma\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, but also is closely associated with a number of extra-gastrointestinal diseases\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. \u003cem\u003eH. pylori\u003c/em\u003e infection is a major risk factor for the development of gastric cancer\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, and among the cancers caused by various pathogens, gastric cancer caused by \u003cem\u003eH. pylori\u003c/em\u003e infection is the first one, surpassing liver cancer caused by hepatitis viruses and cervical cancer caused by human papillomaviruses\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. In 1994, the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) defined \u003cem\u003eH. pylori\u003c/em\u003e as a class I carcinogen\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, and so far, \u003cem\u003eH. pylori\u003c/em\u003e is the only bacterium with this risk level. It is clear that \u003cem\u003eH. pylori\u003c/em\u003e infection-associated diseases are a health threat to families and society. All \u003cem\u003eH. pylori\u003c/em\u003e infections should be considered pathogenic and should be eradicated\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. \u003cem\u003eH. pylori\u003c/em\u003e infection is an infectious disease that can be transmitted from person to person, especially among family members\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The latest studies show that the rate of \u003cem\u003eH. pylori\u003c/em\u003e infection in households in China ranges from 50.27\u0026ndash;85.06%, with an average infection rate of 71.21%, and the rate of \u003cem\u003eH. pylori\u003c/em\u003e infection among individuals in China ranges from 25.33\u0026ndash;59.61%, with an average rate of 40.66%,both show regional variability\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eYunnan Province is located in the border area, where ethnic minorities live, and has unique dietary and living habits. In recent years, because of the favourable climate, more and more families have chosen to visit or even settle in Yunnan, and the health and hygiene conditions in Yunnan are getting more and more attention. There has not been any epidemiological survey of \u003cem\u003eH. pylori\u003c/em\u003e in Yunnan Province based on households, and the status of household \u003cem\u003eH. pylori\u003c/em\u003e infections, related factors, and modes of transmission have not yet been evaluated. Therefore, in the face of such a severe situation of \u003cem\u003eH. pylori\u003c/em\u003e infection prevention and treatment, it is important to understand the current situation of \u003cem\u003eH. pylori\u003c/em\u003e infection in households in Yunnan Province, which is of great significance for the prevention and treatment of \u003cem\u003eH. pylori\u003c/em\u003e in the province.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eAccording to the formula: n\u0026thinsp;=\u0026thinsp;z\u003csup\u003e2\u003c/sup\u003ep(1-p)/d\u003csup\u003e2\u003c/sup\u003e (n, z, p, and d are sample size, z value, positive rate, and acceptable error, respectively), the sample size was calculated, and the prevalence rate of households was about 50%, the test level was 0.05, the confidence level was 0.95, and the permissible error was 3%, and we found out that the Z value was 1.96 by consulting the table of the standard normal distribution, and a total of 1,067 households needed to be included.Considering the additional bias of the convenience sampling method, we finally included 1176 households.The study was conducted from August 2021 to November 2023 in six prefectures of Yunnan Province, including Kunming, Baoshan, Lincang, Qujing, Xishuangbanna Dai Autonomous Prefecture, and Honghe Hani and Yi Autonomous Prefecture(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), in which 1,176 families and 2,947 eligible volunteers were randomly selected and enrolled in this study. The screening and registration process in each prefecture was carried out by postgraduate students from the Department of Gastroenterology at the First Affiliated Hospital of Kunming Medical University, medical staff from local tertiary hospitals, and trained volunteers.Households with \u0026ge;\u0026thinsp;2 household members (living continuously for more than 10 months per year) were invited to participate in the survey. Families were excluded from the study if they had a family member who had taken antibiotics, bismuth, or proton pump inhibitors within 4 weeks, a history of major gastric resection, active bleeding from the upper gastrointestinal tract within 1 week, and women who were preparing for pregnancy, were pregnant, or were breastfeeding.Households with \u0026ge;\u0026thinsp;1 household member infected with \u003cem\u003eH. pylori\u003c/em\u003e are recognised as positive households.The study was approved by the Ethics Committee of the First Affiliated Hospital of Kunming Medical University(No. 148, 2022), and all enrolled participants or their guardians complied with the voluntary principle and signed the relevant informed consent forms.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cp\u003eAll participating family members or their guardians filled out a questionnaire\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The questionnaire mainly included demographic characteristics (e.g., gender, age, occupation, etc.), socio-economic situation (e.g., annual household income and education level, etc.), personal and family living habits (e.g., hand hygiene, family dietary habits, etc.), and past medical history. The questionnaires were completed both electronically and on paper, and specially trained enumerators administered the questionnaires on-site to all participants or their guardians on a one-to-one basis, carefully collecting data and excluding invalid questionnaires.\u003c/p\u003e\n\u003ch3\u003eHelicobacter pylori test\u003c/h3\u003e\n\u003cp\u003eIn this study, \u003cem\u003eH. pylori\u003c/em\u003e testing was performed on all included members according to the instructions of the HUBT-20A \u003cem\u003eH. pylori\u003c/em\u003e detector and urea [14C] breath test kit (Shenzhen Zhongguo Haidui Biotechnology Co., Ltd.), and the HY-IREXB Carbon 13 Breathalyzer and Urea [13C] Breath Test Diagnostic Kit (Beijing Huagananbang Science and Technology Co., Ltd.).The sensitivity and specificity of the two tests were similar and both had high accuracy.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS 25.0 software. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and categorical variables were expressed as numbers and percentages. Continuous variables were compared using the t-test or Fisher's exact probability method, and categorical variables were compared using the chi-square test. Risk factor analyses were performed using multifactor logistic regression modelling, and all variables were included in the model(stepwise, sls\u0026thinsp;=\u0026thinsp;0.10,sle\u0026thinsp;=\u0026thinsp;0.05). Contrast ratios (OR) and 95% confidence intervals (CI) were calculated, and differences were considered statistically significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003e \u003cb\u003eH. pylori\u003c/b\u003e \u003cb\u003einfection status of individuals\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 2947 subjects were examined, 927 were \u003cem\u003eH. pylori\u003c/em\u003e-positive and 2020 were \u003cem\u003eH. pylori\u003c/em\u003e-negative, giving an overall infection rate of 31.46%.Among them, the infection rate of minors(less than 18 years old) was 11.54% (15/130), and the infection rate of adults was 32.37% (912/2817), with statistically significant differences in the \u003cem\u003eH. pylori\u003c/em\u003e infection rates of individuals of different ages (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), showing a trend of increasing with age(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The infection rate of the southern region of Yunnan was the lowest at 21.24% (100/467), and that of the western region of Yunnan was the The highest 46.10% (248/538), the difference of \u003cem\u003eH. pylori\u003c/em\u003e infection rate among individuals in different geographical locations was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05)(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003eIn univariate analysis, the risk of \u003cem\u003eH. pylori\u003c/em\u003e infection was higher among those who lived outside of southern Yunnan, had family members living together for \u0026ge;\u0026thinsp;1 year, were adults, and were married (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, the risk of \u003cem\u003eH. pylori\u003c/em\u003e infection was lower among those with education level of college or above, occupation other than farmer, frequent eating out, gastroscopy within 5 years, and previous \u003cem\u003eH. pylori\u003c/em\u003e examination (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultifactorial logistic regression analysis showed that, on the individual side, living outside of southern Yunnan (eg, Central OR 1.41, 95% CI 1.10\u0026ndash;1.81), having a family member living together for \u0026ge;\u0026thinsp;1 year (OR 2.43, 95% CI 1.49\u0026ndash;3.95), being \u0026ge;\u0026thinsp;18 years old (eg, 18\u0026ndash;44 years old: OR 3.51, 95% CI 1.98\u0026ndash;6.23), and gastrointestinal discomfort within the last 1 year (OR 1.25, 95% CI 1.04\u0026ndash;1.50) were independent risk factors for \u003cem\u003eH. pylori\u003c/em\u003e infection in the study population in Yunnan Province, whereas an education level of college/university and above (OR 0.62, 95% CI 0.48\u0026ndash;0.79), and a gastroscopy within 5 years (OR 0.58, 95% CI 0.46\u0026ndash;0.73) were independent protective factors for their \u003cem\u003eH. pylori\u003c/em\u003e infection (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral personal information and risk factors for \u003cem\u003eH. pylori\u003c/em\u003e infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePositive for \u003cem\u003eH. pylori\u003c/em\u003e, N(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNegative for \u003cem\u003eH. pylori\u003c/em\u003e, N(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eGeographical areas\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e467(15.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100(21.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e367(78.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1816(61.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e523(28.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1293(71.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.48(1.16\u0026ndash;1.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.41(1.10\u0026ndash;1.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNortheast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126(4.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56(44.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70(55.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.94(1.94\u0026ndash;4.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.75(2.43\u0026ndash;5.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e538(18.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248(46.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e290(53.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.14(2.38\u0026ndash;4.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.12(2.35\u0026ndash;4.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe time living together\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133(4.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(15.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112(84.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2814(95.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e906(32.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1908(67.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.53(1.58\u0026ndash;4.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.43(1.49\u0026ndash;3.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1173(39.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e363(30.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e810(69.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1774(60.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e564(31.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1210(68.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.04(0.89\u0026ndash;1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130(4.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(11.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115(88.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;44 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1013(34.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e266(26.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e747(73.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.73(1.57\u0026ndash;4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.51(1.98\u0026ndash;6.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;59 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1114(37.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e389(34.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e725(65.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.11(2.37\u0026ndash;7.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.60(2.62\u0026ndash;8.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e690(23.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e257(37.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e433(62.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.55(2.60\u0026ndash;7.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.00(2.83\u0026ndash;8.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2256(76.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e712(31.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1544(68.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinority\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e691(23.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215(31.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e476(68.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.98(0.82\u0026ndash;1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResident location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1114(37.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e336(30.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e778(69.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1833(62.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e591(32.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1242(67.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.10(0.94\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e425(14.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82(19.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e343(80.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2522(85.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e845(33.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1677(66.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.11(1.63\u0026ndash;2.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school or lower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e818(27.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e300(36.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e518(63.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle/high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1182(40.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e386(32.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e796(67.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84(0.69\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.91(0.75\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.370\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e947(32.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e241(25.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e706(74.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.59(0.48\u0026ndash;0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.62(0.48\u0026ndash;0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1069(36.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e389(36.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e680(63.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-farmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e983(33.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e291(29.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e692(70.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.74(0.61\u0026ndash;0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e216(7.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(14.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e184(85.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.30(0.21\u0026ndash;0.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed/retired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e679(23.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215(31.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e464(68.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81(0.66\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrink raw water\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2482(84.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e765(30.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1717(69.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e465(15.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162(34.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e303(65.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.20(0.97\u0026ndash;1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWashing hands before meal and after defecation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e295(10.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103(34.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e192(65.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2652(89.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e824(31.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1828(68.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84(0.65\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFrequency of eating out\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2379(80.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e771(32.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1608(67.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than two days per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e568(19.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156(27.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e412(72.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79(0.64\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGastrointestinal symptoms within last 1 year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1990(67.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e610(30.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1380(69.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e957(32.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e317(33.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e640(66.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.12(0.95\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.25(1.04\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGastroscopy within 5 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2402(81.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e791(32.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1611(67.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e545(18.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136(24.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e409(75.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.68(0.55\u0026ndash;0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.58(0.46\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreviously tested for\u003c/b\u003e \u003cb\u003eH. pylori\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2466(83.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e804(32.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1662(67.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e481(16.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123(25.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e358(74.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71(0.57\u0026ndash;0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of gastroduodenal surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2908(98.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e913(31.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1995(68.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39(1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(35.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(64.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.22(0.63\u0026ndash;2.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eH. pylori\u003c/b\u003e \u003cb\u003einfection status of Household\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 1176 households were included in this study, and the results showed that there were 642 \u003cem\u003eH. pylori\u003c/em\u003e-positive households and 534 \u003cem\u003eH. pylori\u003c/em\u003e-negative households, with a total household infection rate of 54.59%. Of the 1176 households, 45.41% (534/1176) had no member infected, 35.54% (418/1176) had one member infected and 11.14% (131/1176) had all members infected.The lowest infection rate was 43.02% (77/179) in southern Yunnan, and the highest rate was 69.50% (139/200) in western Yunnan, with statistically significant differences in the rate of \u003cem\u003eH. pylori\u003c/em\u003e infection in households in different geographic locations (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05)(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB). Household infection rates increase with the number of family members(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn univariate analysis, the risk of \u003cem\u003eH. pylori\u003c/em\u003e infection was higher (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in households living outside of southern Yunnan, having\u0026thinsp;\u0026gt;\u0026thinsp;2 persons living together in the household, and drinking heated tap water. In contrast, the risk of \u003cem\u003eH. pylori\u003c/em\u003e infection was lower (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in households with an annual household income\u0026thinsp;\u0026ge;\u0026thinsp;100,000, a total household living area\u0026thinsp;\u0026ge;\u0026thinsp;60 m\u0026sup2;, a split meal system for family meals, and the use of communal chopsticks and spoons for family mealse (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultifactorial logistic regression analysis showed that, in terms of family, living outside of southern Yunnan (eg, Central OR 1.52, 95% CI 1.07\u0026ndash;2.18), and having\u0026thinsp;\u0026ge;\u0026thinsp;3 people living together in the family (eg, 3\u0026ndash;4 people: OR 2.04, 95% CI 1.52\u0026ndash;2.72) were independent risk factors for \u003cem\u003eH. pylori\u003c/em\u003e infection in study families in Yunnan Province, whereas an annual household income of \u0026ge;\u0026thinsp;100,000 ( OR 0.68, 95% CI 0.51\u0026ndash;0.90), total household living area\u0026thinsp;\u0026ge;\u0026thinsp;60 m2 (OR 0.62, 95% CI 0.39\u0026ndash;0.97), the use of separate meals for intra-household gatherings (OR 0.56, 95% CI 0.38\u0026ndash;0.85), and the use of communal spoons and chopsticks (OR 0.38, 95% CI 0.28\u0026ndash;0.52) were the independent protective factorse (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral family information and risk factors for \u003cem\u003eH. pylori\u003c/em\u003e infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePositive for \u003cem\u003eH. pylori\u003c/em\u003e, N(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNegative for \u003cem\u003eH. pylori\u003c/em\u003e, N(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeographical areas\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179(15.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77(43.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102(56.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e741(63.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e388(52.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e353(47.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.46(1.05\u0026ndash;2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.52(1.07\u0026ndash;2.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNortheast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(67.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(32.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.80(1.48\u0026ndash;5.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.77(1.41\u0026ndash;5.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200(17.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139(69.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61(30.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.02(1.98\u0026ndash;4.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.34(2.12\u0026ndash;5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily size(n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e802(68.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e393(49.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e409(51.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e324(27.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e207(63.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117(36.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.84(1.41\u0026ndash;2.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.04(1.52\u0026ndash;2.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50(4.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(84.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(16.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.46(2.53\u0026ndash;11.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.86(3.06\u0026ndash;15.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResident location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e415(35.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e219(52.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196(47.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e761(64.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e423(55.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e338(44.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.12(0.88\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnnual incomee (yuan)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e856(72.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e483(56.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e373(43.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e320(27.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159(49.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e161(50.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76(0.59\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.68(0.51\u0026ndash;0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold living area(㎡)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108(9.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69(63.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39(36.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1068(90.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e573(53.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e495(46.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.65(0.43\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.62(0.39\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnimals in household\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e890(75.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e477(53.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e413(46.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e286(24.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165(57.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121(42.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.18(0.90\u0026ndash;1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSources of drinking water\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBottled water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e619(52.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e317(51.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e302(48.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTap water(heated)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e474(40.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e274(57.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200(42.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.31(1.03\u0026ndash;1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83(7.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51(61.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(38.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.52(0.95\u0026ndash;2.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDish washing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStill water / basin wash\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e246(20.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138(56.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108(43.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlow washing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e930(79.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e504(54.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e426(45.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.93(0.70\u0026ndash;1.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTableware sterilisation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e788(67.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e442(56.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e346(43.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e388(32.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200(51.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e188(48.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.83(0.65\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSeparate dining\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1024(87.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e588(57.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e436(42.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e152(12.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(35.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98(64.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.41(0.29\u0026ndash;0.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.56(0.38\u0026ndash;0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUse communal chopsticks and spoons\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e877(74.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e538(61.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e339(38.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e299(25.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104(34.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e195(65.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.34(0.26\u0026ndash;0.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.38(0.28\u0026ndash;0.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily history of gastric cancer or peptic ulcers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e971(82.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e522(53.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e449(46.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e205(17.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120(58.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85(41.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21(0.90\u0026ndash;1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003eH. pylori\u003c/em\u003e infects half of the world's population and is a major health threat to Chinese families and society. The traditional \"Test and treat\" and \"Screen and treat\" have long been the strategies for treating \u003cem\u003eH. pylori\u003c/em\u003e infection\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, however, in recent years, with the advancement of clinical practice and public awareness, \u003cem\u003eH. pylori\u003c/em\u003e infection in the family has been more widely noticed, and more and more studies and guidelines have pointed out that \u003cem\u003eH. pylori\u003c/em\u003e can be transmitted between people, especially among family members, and that \u003cem\u003eH. pylori\u003c/em\u003e infection has an obvious family aggregation\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Therefore, preventing and controlling infections among family members is a practical way to block the chain of transmission and reduce the rate of infection in society. Starting from the new important strategy of \"family-based \u003cem\u003eH. pylori\u003c/em\u003e infection control and management\"\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, Yunnan Province conducted the first family-based \u003cem\u003eH. pylori\u003c/em\u003e epidemiological survey in the province, which provided a new understanding of the status of family-based \u003cem\u003eH. pylori\u003c/em\u003e infections in Yunnan Province as well as in the whole country.\u003c/p\u003e \u003cp\u003eThe results of this study showed that the \u003cem\u003eH. pylori\u003c/em\u003e infection rate in Yunnan Province was 31.46% (927/2947) in individuals and 54.59% (642/1176) in families, with more than half of the families infected with \u003cem\u003eH. pylori\u003c/em\u003e, and the rate of \u003cem\u003eH. pylori\u003c/em\u003e infection in families was significantly higher than that in individuals, which is in line with previous studies\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. In terms of the regional distribution of infections, there were significant differences in the prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infections among the four different geographic locations, namely, southern Yunnan, central Yunnan, northeastern Yunnan, and western Yunnan, both in terms of individuals and families.It can be seen that there are regional differences in \u003cem\u003eH. pylori\u003c/em\u003e infections, which can be caused by a variety of factors such as socio-economic conditions, cultural customs, and living and dietary habits, etc. Therefore, it is very important that prevention, control, and treatment strategies be tailored to the needs of the local context, and, of course, the artificial interventions adopted in the prevention and control of \u003cem\u003eH. pylori\u003c/em\u003e infections in different countries and regions are very important. Of course, the human intervention in the prevention and control of \u003cem\u003eH. pylori\u003c/em\u003e infection in different countries and regions is also an influencing factor of the local epidemiological trend.However, there was no significant difference in the prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infections between different regions in Hainan Province\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn terms of changes in infection rates, a continued decline in \u003cem\u003eH. pylori\u003c/em\u003e infection rates has been reported in many parts of the world, including South Korea\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, China\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, Austria\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, Iran\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, and Malaysia\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.Meta-analyses in recent years have shown that the global \u003cem\u003eH. pylori\u003c/em\u003e infection rate has declined from 58.2% during the period 1980\u0026ndash;1990 to 43.1% during the period 2011\u0026ndash;2022\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, and that the \u003cem\u003eH. pylori\u003c/em\u003e infection rate in our country has declined by 0.9% per year during the period 1983\u0026ndash;2018, from 63.8% in 1983\u0026ndash;1994 to 2006\u0026ndash;2018 as 46.7%\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. A Japanese study predicts a further decline in \u003cem\u003eH. pylori\u003c/em\u003e prevalence by 2050\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.The continuous decline in infection rates at home and abroad is related to improvements in education, the economy, and sanitation, as well as increasing public health awareness. In recent years, \u003cem\u003eH. pylori\u003c/em\u003e health education has been continuously carried out in our province to standardise the diagnosis and treatment of \u003cem\u003eH. pylori\u003c/em\u003e, and has been improved in clinical practice. In this study, the overall personal infection rate (31.46%) and the personal infection rate (21.41%) in the southern Yunnan region of our province were lower than the survey data of Wang Lan in 2018, 45.29% and 43.01%,and the personal infection rate (28.8%) in the central Yunnan region was also lower than the survey data of Jia Demei et al. in 2013\u0026ndash;2015, 33.5%; in addition, the household infection rate, In addition, the household infection rate (54.59%) and individual infection rate (31.46%) are lower than the national household infection rate (71.21%) and individual infection rate (40.66%) in 2022, which shows that the prevention and treatment effect is remarkable.\u003c/p\u003e \u003cp\u003eYunnan Province is located in the southwestern border of China, dominated by mountains and plateaus, with great terrain undulations, obvious climatic differences in different places, and the concentration of ethnic minorities in the territory, creating unique dietary habits and living conditions in different places. In this study, the \u003cem\u003eH. pylori\u003c/em\u003e infection rate of families and people in southern Yunnan, such as Xishuangbanna and Honghe, was significantly lower than that of people in central Yunnan, northeastern Yunnan, and western Yunnan (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which may be related to the fact that people in southern Yunnan like to eat spicy and stimulating foods, and pepper oil, chilli pepper, and garlic are added to their dipping sauces, which were found to have an antimicrobial or bacteriostatic effect on Helicobacter pylori in the stomach in previous studies\u003csup\u003e[\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cem\u003eH. pylori\u003c/em\u003e is mainly transmitted within the family through the oral-oral, faecal-oral, and shared utensil routes and is difficult to self-clean after infection\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.Longer time of family members living together means that the exposure time and frequency of certain risk factors increase, leading to the formation of oral-oral or faecal-oral chain of transmission of \u003cem\u003eH. pylori\u003c/em\u003e within the family through some medium, which results in infections.National studies have shown that when couples cohabit from 5 years to 30 years, the The prevalence of infection increased from 17\u0026ndash;22%-24%\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, and in this study it was also shown that the prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection was 2.43 times higher in those whose family members had been living together for \u0026ge;\u0026thinsp;1 year than in those who had been living together for \u0026lt;\u0026thinsp;1 year (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which in some sense proves the clustering of infection in the family.\u003c/p\u003e \u003cp\u003eRegarding the relationship between age and \u003cem\u003eH. pylori\u003c/em\u003e infection, different studies have different views. Alarid-Escudero et al. \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003econducted a mathematical model to assess the potential risk of \u003cem\u003eH. pylori\u003c/em\u003e infection in Mexico, and this model estimated that \u003cem\u003eH. pylori\u003c/em\u003e infection force is highest at birth and decreases to zero with age.In this study, the \u003cem\u003eH. pylori\u003c/em\u003e infection rate increased with age, and the old age group (\u0026ge;\u0026thinsp;60 years old) had the highest infection rate, which is consistent with the study of Danni Liu et al.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e in Hainan, and the \u003cem\u003eH. pylori\u003c/em\u003e infection rate of the middle-aged group (45\u0026ndash;59 years old) and the old age group (\u0026ge;\u0026thinsp;60 years old) exceeded the average infection rate of Yunan Province, which is a priority for the prevention and control of \u003cem\u003eH. pylori\u003c/em\u003e infection in these two age groups.\u003c/p\u003e \u003cp\u003eThe relationship between \u003cem\u003eH. pylori\u003c/em\u003e infection and ethnicity has been reported differently in different studies. The ethnic structure of Malaysia consists of three main Asian races including Malays, Chinese and Indians. Indians had the highest prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection (\u0026gt;\u0026thinsp;50%), followed by Chinese (40%-50%), while Malays had a relatively low prevalence of about 10%-20%\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, suggesting that \u003cem\u003eH. pylori\u003c/em\u003e spreads predominantly within ethnicity. In contrast, there was no significant difference in the prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection between the Han nationality and ethnic minority populations in the study in Hainan Province\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, which is consistent with this study. The residence status of all ethnic groups in China is \"big mixed residence, small settlement\", and this form of distribution is conducive to the interaction of all ethnic groups, and the free intermarriage between different ethnic groups may make the influence of host genetic factors and the distribution of strains among ethnic groups less and less.\u003c/p\u003e \u003cp\u003eHigher educated people have good hygiene and dietary habits, and have higher acceptance and compliance to health education information, and this study shows that higher educated people have lower \u003cem\u003eH. pylori\u003c/em\u003e infection rate, which is consistent with related research reports\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTraditionally, many people believe that eating out is a hygiene hazard and that it is easy to \"spread disease from mouth to mouth\". Previous studies have shown that people who eat out more frequently are at higher risk of \u003cem\u003eH. pylori\u003c/em\u003e infection\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Interestingly, the results of this study showed that the risk of \u003cem\u003eH. pylori\u003c/em\u003e infection was significantly lower in those who ate out more frequently (more than 2 days per week) than those who rarely ate out. People in Yunnan often use fermented foods for flavouring dishes, especially in the catering industry, such as tempeh and pickles, in which the probiotics may inhibit the growth of \u003cem\u003eH. pylori\u003c/em\u003e. In recent years, with socio-economic development and greatly improved hygiene conditions, the catering industry has stricter hygiene standards, and the technology and frequency of disinfection of tableware even exceeds that of some families with low hygiene concepts. After the tableware has been sterilised and divided, the risk of infection is reduced. In addition, when eating out, separate meals and the use of communal chopsticks are more common, which reduces the chance of cross-infection brought about by sharing tableware. Dining out offers a wide variety of food choices, and the intake of vegetables and fruits is rich in antioxidants, which may help to suppress H. pylori. Moreover, people who eat out more often are usually better off and have access to better medical services and health protection. These factors above are not absolute and are subject to further research.\u003c/p\u003e \u003cp\u003e \u003cem\u003eH. pylori\u003c/em\u003e infected people present with varying degrees of gastrointestinal symptoms, and the prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection was higher among people with gastrointestinal symptoms in the past 1 year in this study, so it is more important for symptomatic people to be screened for \u003cem\u003eH. pylori\u003c/em\u003e in time to prevent further transmission and the development of related diseases. However, this was not found in previous studies. Currently, advanced endoscopic technology allows for a high degree of accuracy in the diagnosis of gastrointestinal lesions, and most gastroenterologists will ask patients to complete an \u003cem\u003eH. pylori\u003c/em\u003e test if gastroscopy reveals a lesion, and will recommend eradication treatment if there is an infection with no contraindications to eradication, and if there is no infection, some patients will also undergo outpatient counselling or Internet consultation, which will increase their awareness of \u003cem\u003eH. pylori\u003c/em\u003e, and then undergo \u003cem\u003eH. pylori\u003c/em\u003e screening. In this study, the \u003cem\u003eH. pylori\u003c/em\u003e infection rate was lower in those who had undergone gastroscopy within 5 years compared to those who had not, which was considered to be related to the above factors.\u003c/p\u003e \u003cp\u003eWith a large family size, the living environment is relatively crowded, with poor environmental hygiene, close contact between family members, and the superposition of risk factors, which provide favourable conditions for the spread of \u003cem\u003eH. pylori\u003c/em\u003e within the family, and the present study found that families with a large number of people living together had a high rate of \u003cem\u003eH. pylori\u003c/em\u003e infection, which is consistent with previous studies\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAnnual household income and household living area represent the socio-economic status of a family. Families with high annual household income and large total living area also have relatively better family hygiene, living conditions, education level and working environment, and the risk of \u003cem\u003eH. pylori\u003c/em\u003e infection is lower. Firstly, better-off families can afford better healthcare services, including \u003cem\u003eH. pylori\u003c/em\u003e testing and treatment, which can reduce infection rates. Secondly, higher-income families usually have larger family living space, better living and hygienic conditions, such as better ventilation and lighting conditions, clean drinking water and food, clean kitchens and bathrooms, and regular cleaning of furnished environments, which can help to reduce bacterial growth and transmission. Lastly, people with a high level of education usually have a better sense of hygiene and are able to take effective preventive measures, such as washing hands frequently and using communal chopsticks, etc. They are also more inclined to undergo regular medical check-ups and seek timely medical treatment, which can help in early detection and treatment, thereby reducing the infection rate. All these factors tend to interact with each other. For example, people with a higher level of education usually have a higher income and are able to improve their living conditions, further reducing the infection rate. Our findings also confirm that households with higher socioeconomic levels have lower \u003cem\u003eH. pylori\u003c/em\u003e infection rates, consistent with previous studies\u003csup\u003e[\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition to humans, some animals, such as cattle and sheep, may also be hosts for \u003cem\u003eH. pylori\u003c/em\u003e\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e, although no correlation was found between having animals in the home and \u003cem\u003eH. pylori\u003c/em\u003e in the home in this study.\u003c/p\u003e \u003cp\u003eIn Bogot\u0026aacute;, Colombia, long-term sampling of water sources showed that \u003cem\u003eH. pylori\u003c/em\u003e DNA was found in 31% and 38.7% of raw water and drinking water samples, respectively\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. In Peru, the intake of unboiled water (93.9%) and watercress (79.6%) were found to be the most important factors associated with \u003cem\u003eH. pylori\u003c/em\u003e infection in children\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. In the United Arab Emirates, the prevalence of \u003cem\u003eH. pylori\u003c/em\u003e was significantly higher among tap water drinkers than among bottled water drinkers\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. In the present study, the risk of \u003cem\u003eH. pylori\u003c/em\u003e infection was higher in households consuming heated tap water compared to those consuming bottled water. Therefore, untreated tap water should not be used as a source of drinking water in the home.\u003c/p\u003e \u003cp\u003eThe oral cavity is the first gateway for \u003cem\u003eH. pylori\u003c/em\u003e to enter the human body, and many scholars have applied molecular biology and immunological methods to detect oral \u003cem\u003eH. pylori\u003c/em\u003e in dental plaque, saliva, tongue, and dental pulp\u003csup\u003e[\u003cspan additionalcitationids=\"CR36 CR37\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e, and \u003cem\u003eH. pylori\u003c/em\u003e DNA has even been detected on chopsticks\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e.In Chinese families, the use of chopsticks to hold food when sharing a meal with family and friends has been a part of the Chinese culture for centuries, and the practice of mouth-to-mouth feeding of young children is a common phenomenon in families. The feeding of young children with mouth-to-mouth is a frequent occurrence in families, which inadvertently transmits pathogens through the oral component.Z. Ding et al.\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e found that eating alone was an independent protective factor against \u003cem\u003eH. pylori\u003c/em\u003e infection.Using of communal chopsticks and spoons reduced the risk of \u003cem\u003eH. pylori\u003c/em\u003e infection in the family\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.In the present study, the low rate of \u003cem\u003eH. pylori\u003c/em\u003e infection in families that used communal chopsticks and spoons and a split-meal diet is in line with previous studies, and provides evidence for the oral-oral route of transmission, and emphasises the importance of implementing home-based control and management of \u003cem\u003eH. pylori\u003c/em\u003e infection in clinical practice.\u003c/p\u003e \u003cp\u003eTo raise public awareness of the prevention of H. pylori infection, good hygiene practices should be further promoted through community health activities, media campaigns, school education, etc., taking into account the local conditions.\u003c/p\u003e \u003cp\u003eBecause the sample size was large enough, the common method of performing univariate analyses was used and then all the variables were included in the multivariate model and stepwise regression was used for the control of variable inclusion. Also for categorical variables such as geographic location, education level, etc., they were converted to dummy variables to view the stratification effect, and age as a continuous variable was also grouped. Confounding factors in this study have been controlled as much as possible.\u003c/p\u003e \u003cp\u003eThere are some limitations to this study. First, the survey used a convenience sampling method, which may limit generalisations and bias the overall selection, but because of the large sample size, the impact was small. Second, the detection method used only the urea breath test, which can only represent a presenting infection and can be made more accurate by combining it with serological or faecal antigen testing. Third, this work was conducted in Yunnan Province and the definition of geographical areas is not precise in terms of latitude and longitude, the results may not be applicable to other regions. Fourth, The 50% prevalence assumption for sample size calculation lacks previous epidemiological surveys and may not reflect the true baseline rate. We acknowledge any bias in data collection or reporting.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe overall rate of \u003cem\u003eH. pylori\u003c/em\u003e infection in Yunnan Province is lower than the national average, with variations by region.There is family aggregation of \u003cem\u003eH. pylori\u003c/em\u003e infection, and the risk factors for infection are closely related to demographic and sociological characteristics, family characteristics, and individual and family living habits. Therefore, the prevention and control of \u003cem\u003eH. pylori\u003c/em\u003e infection should be tailored to local conditions, and comprehensive measures should be developed on a family basis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in strict accordance with the Declaration of Helsinki.The study was approved by the Ethics Committee of the First Affiliated Hospital of Kunming Medical University, and all enrolled participants or their guardians complied with the voluntary principle and signed the relevant informed consent forms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Yunnan Leading Talent Programme(L-2019024), National Clinical Key Specialty Construction Project and Yunnan Province \"High-level Talent Cultivation Support Program\" Famous Doctor Special Project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLanqing Ma conceived and designed the study. Yunran Yang, Qingqing Zhou, Yu Li, Da Wang, Dan Zhang, Yule He, Hang Chen, Minshan Huang collected the data. Kunpeng Na and Lan Liu analyzed the data. Ying Wan wrote the article. Dingyun You, Le Cai, Yongmei Wu review the manuscript and give some advices.The manuscript was critically reviewed and approved by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the leaders and team members of the participating hospitals(Listed in alphabetical order by last name). Dr Bai Jianping, Dr Xia Benlin, Dr Qian Chongxiang and Dr Wang Xin from the First People's Hospital of Honghe State; Dr Chen Lifang, Dr Luo Sufeng and Dr Feng Jingfang from The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture; Dr Ren Li, Dr Lv Minghua, Nurse Qiu Hongxing and Nurse Zhang E from Huize County People's Hospital; Dr Yang Taiming, Dr Liu Yan, Dr Yang ningling and Dr Yang Mengying from Lincang People's Hospital; Dr Zhang Hao and Dr Zao Chunhua from the Baoshan People's Hospital.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWarren J R, Marshall B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis [J]. Lancet, 1983, 1(8336): 1273-1275.\u003c/li\u003e\n\u003cli\u003eMalfertheiner P, Megraud F, Rokkas T, Gisbert J P, Liou J M, Schulz C, Gasbarrini A, Hunt R H, Leja M, O\u0026apos;Morain C, Rugge M, Suerbaum S, Tilg H, Sugano K, El-Omar E M. 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Aliment Pharmacol Ther, 2015, 42(8): 1019-1026.\u003c/li\u003e\n\u003c/ol\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":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Helicobacter pylori, Family-based, Epidemiological, Ethnic minority, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-5466692/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5466692/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe status of family-based \u003cem\u003eH. pylori\u003c/em\u003e infection in Yunnan Province is unknown. This study is the first family-based epidemiological survey of \u003cem\u003eH. pylori\u003c/em\u003e in the province, aiming to provide new insights into the status of family-based \u003cem\u003eH. pylori\u003c/em\u003e infections in Yunnan Province as well as in the country as a whole.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eBetween 2021 and 2023, 1,176 families with 2,947 family members were tested for \u003cem\u003eH. pylori\u003c/em\u003e in six cities in Yunnan Province with different geographic locations and economic status, to assess the status of \u003cem\u003eH. pylori\u003c/em\u003e infection, and to clarify the related factors and modes of transmission by means of a questionnaire survey.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn Yunnan Province, the \u003cem\u003eH. pylori\u003c/em\u003e infection rate was 31.46% (927/2947) in people and 54.59% (642/1176) in families.On the individual side, living outside of southern Yunnan (eg, Central OR 1.41, 95% CI 1.10\u0026ndash;1.81), having a family member living together for \u0026ge;\u0026thinsp;1 year (OR 2.43, 95% CI 1.49\u0026ndash;3.95), being \u0026ge;\u0026thinsp;18 years old (eg, 18\u0026ndash;44 years old: OR 3.51, 95% CI 1.98\u0026ndash;6.23), and gastrointestinal discomfort within the last 1 year (OR 1.25, 95% CI 1.04\u0026ndash;1.50) were independent risk factors for \u003cem\u003eH. pylori\u003c/em\u003e infection in the study population in Yunnan Province, whereas an education level of college/university and above (OR 0.62, 95% CI 0.48\u0026ndash;0.79), and a gastroscopy within 5 years (OR 0.58, 95% CI 0.46\u0026ndash;0.73) were independent protective factors for their \u003cem\u003eH. pylori\u003c/em\u003e infection. In terms of family, living outside of southern Yunnan (eg, Central OR 1.52, 95% CI 1.07\u0026ndash;2.18), and having\u0026thinsp;\u0026ge;\u0026thinsp;3 people living together in the family (eg, 3\u0026ndash;4 people: OR 2.04, 95% CI 1.52\u0026ndash;2.72) were independent risk factors for \u003cem\u003eH. pylori\u003c/em\u003e infection in study families in Yunnan Province, whereas an annual household income of \u0026ge;\u0026thinsp;100,000 ( OR 0.68, 95% CI 0.51\u0026ndash;0.90), total household living area\u0026thinsp;\u0026ge;\u0026thinsp;60 m2 (OR 0.62, 95% CI 0.39\u0026ndash;0.97), the use of separate meals for intra-household gatherings (OR 0.56, 95% CI 0.38\u0026ndash;0.85), and the use of communal spoons and chopsticks (OR 0.38, 95% CI 0.28\u0026ndash;0.52) were the independent protective factorse.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe risk factors of Family-Based \u003cem\u003eH. pylori\u003c/em\u003e infection in Yunnan province were closely related to demographic characteristics, personal and family living habits. Close contact with infected family members may be the main cause of transmission. Family-based control of \u003cem\u003eH. pylori\u003c/em\u003e infection should be regarded in clinical practice.\u003c/p\u003e","manuscriptTitle":"Epidemiological Status of Family-Based Helicobacter pylori Infection in Yunnan Province, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-20 05:30:19","doi":"10.21203/rs.3.rs-5466692/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-03-20T07:53:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-19T14:57:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282574131704150811310609137727458955482","date":"2025-03-19T14:46:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-19T10:33:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-19T09:18:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-03-18T18:12:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"817feff7-7e5c-4e62-a384-b545f3f578d6","owner":[],"postedDate":"March 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T15:58:09+00:00","versionOfRecord":{"articleIdentity":"rs-5466692","link":"https://doi.org/10.1186/s12876-025-03806-1","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2025-04-29 15:56:52","publishedOnDateReadable":"April 29th, 2025"},"versionCreatedAt":"2025-03-20 05:30:19","video":"","vorDoi":"10.1186/s12876-025-03806-1","vorDoiUrl":"https://doi.org/10.1186/s12876-025-03806-1","workflowStages":[]},"version":"v1","identity":"rs-5466692","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5466692","identity":"rs-5466692","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}