Interaction Among Ethnicity, Socioeconomic Status, and Helicobacter pylori Seroprevalence in Israeli Children and Adolescents

Objectives: The aim of the study was to examine the prevalence of Helicobacter pylori infection among Israeli children from different backgrounds and to assess potential interactions between ethnicity, socioeconomic status (SES), and H pylori seroprevalence. Patients and Methods: The present sero-epidemiologic study was conducted among 0- to 20-year-old children seeking medical attention, not specifically gastrointestinal symptoms, using sera collected between 2000 and 2001 from 575 Israeli Arab children, 584 Jewish children from the general population, and sera that were obtained between 1997 and 2007 from 464 children of an ultraorthodox Jewish community. An enzyme-linked immunosorbent assay was used to measure H pylori serum immunoglobulin G antibodies and seropositivity to H pylori CagA strains. Results: H pylori seropositivity was 22.9% (95% confidence interval [CI] 19.7-26.5) among Jewish children from the general population, 25.2% (95% CI 21.5-29.4) among ultraorthodox Jewish children, and 45.6% (95% CI 41.5-49.7) among Arab children. H pylori seroprevalence increased significantly with age in the 3 study groups, but it was consistently higher in Arab children. Compared with Jewish participants from high SES and controlling for age and sex, the odds ratio for H pylori seropositivity was 2.03 (95% CI 1.31-3.12) in Jewish children from intermediate SES, 2.42 (95% CI 1.29-4.53) in Arab children from intermediate SES, 2.26 (95% CI 1.52-3.36) in Jewish children from low SES, and 5.72 (95% CI 3.89-8.42) in Arab children from low SES. CagA seropositivity was 40.8% and 45.0% among Jewish and Arab children, respectively (P = 0.59), and it was highest among subjects of lower SES. Conclusions: Socioeconomic factors may not totally explain the ethnic differences in H pylori prevalence.