Table 2.
H. pylori seropositivity’s association with incident Alzheimer’s disease and all-cause dementia in multiple Cox proportional hazards regression models, overall and stratified by sex, race, age, income, and education groups: NHANES III, phase 1 (1988–1991) alone and combined with NHANES 1999–2000 (pooled sample)
|
H. pylori seropositivity vs. incident outcomes |
Model 1* | Model 2† | Model 3‡ | |||
|---|---|---|---|---|---|---|
| HR (95% CI) | P | HR (95% CI) | P | HR (95% CI) | P | |
| Pooled sample | ||||||
| Alzheimer’ disease | ||||||
| Overall (N = 5876) | 1.19 (0.96–1.49) | .11 | 1.13 (0.90–1.42) | .30 | 1.10 (0.87–1.38) | .42 |
| Men (N = 2937) | 1.56 (1.12–2.18) | .008§ | 1.46 (1.03–2.05) | .031§ | 1.45 (1.03–2.04) | .035§ |
| Women (N = 2939) | 1.03 (0.78–1.37) | .82 | 0.98 (0.73–1.31) | .87 | 0.96 (0.71–1.37) | .71 |
| NH white (N = 3160) | 1.25 (0.98–1.59) | .08 | 1.14 (0.89–1.48) | .30 | 1.11 (0.86–1.45) | .40 |
| NH black (N = 1166) | 1.04 (0.67–1.61) | .87 | 0.96 (0.62–1.50) | .87 | 1.03 (0.65–1.63) | .90 |
| MA (N = 1283) | 1.17 (0.67–2.04) | .58 | 1.11 (0.64–1.9) | .71 | 1.06 (0.59–1.92) | .84 |
| ≤65 y (N = 3216) | 1.19 (0.77–1.85) | .44 | 0.94 (0.60–1.44) | .78 | 0.93 (0.59–1.45) | .74 |
| >65 y (N = 2660) | 1.17 (0.92–1.50) | .20 | 1.16 (0.90–1.50) | .26 | 1.15 (0.88–1.49) | .30 |
| PIR < 100% (N = 932) | 0.64 (0.39–1.05) | .074 | 0.72 (0.44–1.18) | .19 | 0.67 (0.41–1.11) | .12 |
| PIR: 100–200% (N = 1451) | 0.97 (0.65–1.45) | .87 | 0.97 (0.65–1.45) | .87 | 0.94 (0.61–1.45) | .79 |
| PIR: >200% (N = 2712) | 1.43 (1.03–1.99) | .032‖ | 1.42 (1.01–1.98) | .044‖ | 1.40 (0.99–1.97) | .06‖ |
| <HS (N = 1858) | 0.96 (0.63–1.47) | .85 | 0.95 (0.62–1.46) | .81 | 0.90 (0.58–1.40) | .65 |
| HS (N = 2388) | 1.06 (0.76–1.46) | .75 | 1.05 (0.75–1.45) | .79 | 1.06 (0.77–1.48) | .71 |
| >HS (N = 1598) | 1.31 (0.85–2.01) | .23 | 1.32 (0.86–2.02) | .21 | 1.32 (0.85–2.05) | .21 |
| All-cause dementia | ||||||
| Overall (N = 5865) | 1.09 (0.93–1.27) | .30 | 1.03 (0.88–1.21) | .71 | 1.01 (0.86–1.18) | .89 |
| Men (N = 2932) | 1.32 (1.05–1.65) | .018§ | 1.24 (0.98–1.56) | .07§ | 1.23 (0.97–1.56) | .09§ |
| Women (N = 2933) | 0.97 (0.78–1.19) | .74 | 0.92 (0.75–1.14) | .45 | 0.91 (0.73–1.12) | .36 |
| NH white (N = 3157) | 1.08 (0.90–1.29) | .41 | 1.00 (0.83–1.20) | .98 | 0.98 (0.82–1.18) | .86 |
| NH black (N = 1164) | 1.20 (0.88–1.64) | .24 | 1.17 (0.86–1.60) | .32 | 1.21 (0.88–1.65) | .24 |
| MA (N = 1279) | 0.93 (0.63–1.36) | .70 | 0.87 (0.60–1.27) | .47 | 0.83 (0.56–1.22) | .34 |
| ≤65 y (N = 3213) | 1.13 (0.84–1.52) | .41 | 0.97 (0.72–1.31) | .86 | 1.00 (0.74–1.35) | .99 |
| >65 y (N = 2652) | 1.03 (0.87–1.23) | .72 | 1.02 (0.85–1.21) | .86 | 1.00 (0.83–1.20) | 1.00 |
| PIR < 100% (N = 925) | 0.72 (0.50–1.04) | .08 | 0.77 (0.53–1.12) | .18 | 0.71 (0.50–1.01) | .06 |
| PIR: 100–200% (N = 1449) | 0.89 (0.66–1.20) | .45 | 0.89 (0.67–1.21) | .48 | 0.89 (0.66–1.21) | .47 |
| PIR: >200% (N = 2712) | 1.20 (0.96–1.51) | .11‖ | 1.19 (0.94–1.50) | .14‖ | 1.18 (0.93–1.49) | .18‖ |
| <HS (N = 1849) | 0.89 (0.65–1.22) | .46 | 0.84 (0.61–1.16) | .30 | 0.85 (0.61–1.18) | .33 |
| HS (N = 2388) | 1.01 (0.81–1.27) | .90 | 1.00 (0.80–1.26) | .99 | 1.01 (0.80–1.26) | .95 |
| >HS (N = 1596) | 1.18 (0.87–1.61) | .28 | 1.18 (0.88–1.60) | .28¶ | 1.18 (0.87–1.60) | .30¶ |
| NHANES III, phase 1 | ||||||
| Alzheimer’s disease | ||||||
| Overall (N = 3646) | 1.30 (1.00–1.69) | .048 | 1.23 (0.94–1.62) | .13 | 1.21 (0.92–1.60) | .17 |
| Men (N= 1856) | 2.03 (1.32–3.11) | .001§ | 1.95 (1.23–3.08) | .004§ | 1.99 (1.24–3.17) | .004§ |
| Women (N = 1790) | 1.05 (0.76–1.46) | .76 | 0.98 (0.70–1.37) | .89 | 0.96 (0.68–1.35) | .81 |
| NH white (N = 2073) | 1.30 (0.97–1.74) | .08 | 1.21 (0.89–1.64) | .22 | 1.19 (0.87–1.62) | .28 |
| NH black (N = 767) | 1.08 (0.67–1.75) | .75 | 1.03 (0.64–1.65) | .90 | 1.16 (0.71–1.89) | .56 |
| MA (N = 710) | 1.17 (0.58–2.34) | .66 | 1.07 (0.53–2.16) | .86 | 1.06 (0.50–2.27) | .88 |
| ≤65 y (N = 1949) | 1.23 (0.77–1.96) | .39 | 0.96 (0.60–1.52) | .85 | 0.97 (0.61–1.55) | .90 |
| >65 y (N = 1697) | 1.27 (0.94–1.73) | .12 | 1.28 (0.93–1.76) | .13 | 1.24 (0.89–1.73) | .20 |
| PIR < 100% (N = 570) | 0.84 (0.46–1.54) | .58 | 0.80 (0.43–1.50) | .49 | 0.69 (0.37–1.27) | .23 |
| PIR: 100–200% (N = 906) | 1.13 (0.68–1.89) | .64 | 1.12 (0.67–1.89) | .66 | 1.19 (0.68–2.08) | .54 |
| PIR: >200% (N = 1729) | 1.34 (0.93–1.95) | .11 | 1.35 (0.91–1.98) | .13 | 1.30 (0.88–1.93) | .19 |
| <HS (N = 852) | 0.76 (0.44–1.32) | .34 | 0.71 (0.41–1.23) | .22 | 0.66 (0.38–1.15) | .14 |
| HS (N = 1924) | 1.12 (0.80–1.59) | .50¶ | 1.09 (0.77–1.54) | .64¶ | 1.09 (0.77–1.55) | .62¶ |
| >HS (N = 846) | 1.75 (1.02–3.00) | .044¶ | 1.75 (1.01–3.02) | .046¶ | 1.84 (1.05–3.22) | .032¶ |
| All-cause dementia | ||||||
| Overall (N = 3646) | 1.18 (0.98–1.42) | .07 | 1.13 (0.93–1.36) | .21 | 1.11 (0.92–1.34) | .28 |
| Men (N = 1856) | 1.51 (1.13–2.01) | .005§ | 1.44 (1.06–1.95) | .020§ | 1.44 (1.05–1.98) | .022§ |
| Women (N = 1790) | 1.04 (0.82–1.31) | .77 | 0.98 (0.77–1.25) | .88 | 0.97 (0.76–1.24) | .82 |
| NH white (N = 2073) | 1.16 (0.94–1.43) | .16 | 1.10 (0.89–1.35) | .40 | 1.09 (0.87–1.35) | .45 |
| NH black (N = 767) | 1.06 (0.74–1.52) | .74 | 1.04 (0.73–1.49) | .82 | 1.13 (0.78–1.63) | .52 |
| MA (N = 710) | 1.06 (0.67–1.69) | .80 | 0.98 (0.62–1.54) | .91 | 0.92 (0.58–1.47) | .73 |
| ≤65 y (N = 1949) | 1.16 (0.84–1.60) | .37 | 0.96 (0.69–1.34) | .83 | 0.98 (0.70–1.38) | .92 |
| >65 y (N = 1697) | 1.14 (0.91–1.41) | .25 | 1.13 (0.91–1.40) | .28 | 1.10 (0.88–1.38) | .42 |
| PIR < 100% (N = 570) | 0.72 (0.46–1.12) | .15 | 0.71 (0.46–1.10) | .13 | 0.61 (0.39–0.95) | .030 |
| PIR: 100%−200% (N = 906) | 1.08 (0.76–1.55) | .66 | 1.08 (0.76–1.55) | .66 | 1.11 (0.77–1.60) | .57 |
| PIR: >200% (N = 1729) | 1.24 (0.95–1.62) | .11‖ | 1.22 (0.93–1.60) | .15‖ | 1.20 (0.91–1.58) | .19‖ |
| <HS (N = 852) | 0.78 (0.50–1.22) | .28 | 0.74 (0.48–1.16) | .19 | 0.72 (0.46–1.12) | .15 |
| HS (N = 1924) | 1.05 (0.82–1.33) | .71 | 1.02 (0.80–1.29) | .89 | 1.02 (0.80–1.30) | .90 |
| >HS (N = 846) | 1.60 (1.09–2.35) | .017§ | 1.59 (1.08–2.34) | .018 | 1.57 (1.06–2.31) | .023 |
Abbreviations: BMI, body mass index; H. pylori (Hp), Helicobacter pylori; HR, hazard ratio; HS, high school; N, unweighted sample size; NH, non-Hispanic; NHANES, National Health and Nutrition Examination Surveys; PIR, poverty income ratio; MA, Mexican-American.
NOTE. Bold text indicates P<.05. Bold and italic text indicates P<.10.
Cox proportional hazards models with time of follow-up expressed in months since MEC examination. Model 1 was adjusted for age, sex, race, and wave. All models including sampling weights that are specific to NHANES III, phase 1 or combined for the pooled sample. Sample sizes shown are unweighted.
Model 2 is model 1 further adjusted for education and poverty income ratio.
Model 3 is model 2 further adjusted for smoking, weight status, hypertension, diabetes, and dyslipidemia.
P<.05 for interaction term Hp × sex in separate model with Hp and sex retained as main effects.
P<.05 for interaction term Hp × PIR in separate model with Hp and PIR group retained as main effects.
P<.05 for interaction term Hp × EDU in separate model with Hp and EDU group retained as main effects.