Incidence and Risk Factors of Helicobacter pylori Infections Among Asymptomatic Pakistani Tobacco Consumers

OBJECTIVE: This study aimed to assess the incidence of H. pylori infection and its associated risk factors among asymptomatic Pakistani tobacco users, with the goal of informing targeted screening and prevention strategies. METHODS: A cross-sectional study was conducted from September 2024 to February 2025 in Punjab and Khyber Pakhtunkhwa, Pakistan. A total of 129 asymptomatic adults (aged ≥25), reporting regular tobacco use, were enrolled through non-probability purposive sampling from outpatient and community health settings. Non-probability purposive sampling was used to recruit participants who met the study's eligibility criteria. Data were collected using a structured questionnaire and H. pylori stool antigen testing. Descriptive statistics, chi-square tests, and binary logistic regression were used for analysis. RESULTS: The mean age of participants was 38.6 ± 9.2 years, with 68.2% being male. Overall, 34.1% had used tobacco for over five years, and 81.4% reported daily use. H. pylori infection was significantly associated with prolonged tobacco use (>5 years; p = 0.01), use of smokeless tobacco (p = 0.02), consumption of untreated water (p = 0.02), shared sanitation (p < 0.001), and family history of gastric disorders (p < 0.001). Logistic regression revealed that tobacco use >5 years (AOR = 2.34), untreated water (AOR = 1.96), shared sanitation (AOR = 1.89), and family history of gastrointestinal disorders (AOR = 2.67) were independent predictors of infection. CONCLUSION: This study demonstrates a high prevalence of H. pylori infection among asymptomatic tobacco users in Pakistan. Key modifiable risk factors, including prolonged tobacco use and environmental exposures, highlight the need for integrated public health interventions focusing on tobacco cessation, sanitation improvement, and targeted screening.