Z Gastroenterol 2006; 44 - A143
DOI: 10.1055/s-2006-943509

Role of environmental and social factors in gastric cancer mortality in Hungary

K Tamássy 1, A Páldy 2, G Nádor 2, J Szabó 3, L Pásztor 3
  • 1SE Kútvölgyi Clinical Center
  • 2„József Fodor“ National Center for Public Health, National Institute of Environmental Health
  • 3Research Institute for Soil Science and Agricultural Chemistry of the Hungarian Academy of Sciences

Introduction: Inadequate sanitation practices, low social class, and crowded or high-density living conditions seem to be related to a higher prevalence of H. pylori infection.

Patients and methods: Spatial differences in mortality from gastric cancer (ICD-10:C16) in both sexes in the age groups of 35–64y and over 65 years was studied by cluster analysis using SCAN method based on GAM-K method for the periods of 1986–1993 and 1994–2004. The association of mortality and 28 socio-economical factors (marital state, education, unemployment, water supply, sanitation) from the 2001 census on settlement level as well as the type of soil (upper layer) was studied by spatial logistic regression method.

Primary care physicians in six counties and Budapest used rapid serological test (Signify H. pylori WholeBlood Test-Biotech Inc.) during the diagnostic procedure of 898 patients (mean age:50.22 y,18–80 y) with recurrent dyspeptic symptoms.

Results: Clusters of gastric cancer mortality were accumulated in West Transdanubia, Northern Hungary and North-Eastern part of the country. Rate of unemployed males, widows and divorced as well as agricultural workers significantly correlated with mortality. Higher education seemed to be protective. Gastric cancer mortality was lower in settlements with piped drinking water and sanitation in the younger age group. In contrary mortality was higher in settlements with soil of good or high water retention compared to sandy soil.

H. pylori positivity rate was 56.57%in the examined population. The lowest prevalence was found in county (44%) Bács-Kiskun with sandy soil and the highest in Hajdú-Bihar (67%) with clay and loamy type soil. The difference was significant, as well as between the prevalence in Bács-Kiskun and Somogy, respectively. Heves county is characterised by clayey soil.

Conclusions: Statistical analysis showed that gastric cancer mortality is associated with social status, agricultural type of work, with sanitation and type of soil. Based on these observations further analytical epidemiological studies are necessary to assess the role of different environmental and social factors in H. pylori infection rate and consequently in the aetiology of gastric cancer.