Associations of Helicobacter pylori and hepatitis A seropositivity with asthma in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL): addressing the hygiene hypothesis

Christian S Alvarez, M Larissa Avilés-Santa, Neal D Freedman, Krista M Perreira, Olga Garcia-Bedoya, Robert C Kaplan, Martha L Daviglus, Barry I Graubard, Gregory A Talavera, Bharat Thyagarajan, M Constanza Camargo, Christian S Alvarez, M Larissa Avilés-Santa, Neal D Freedman, Krista M Perreira, Olga Garcia-Bedoya, Robert C Kaplan, Martha L Daviglus, Barry I Graubard, Gregory A Talavera, Bharat Thyagarajan, M Constanza Camargo

Abstract

Background: The hygiene hypothesis posits that microbial exposure reduces risk of asthma and other respiratory-related diseases. Helicobacter pylori and hepatitis A virus (HAV) are common fecal-oral infections. Our study aimed to examine associations of seropositivity to these agents with asthma in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Methods: A total of 12,471 HCHS/SOL participants with baseline data on self-reported physician-diagnosed asthma, and antibodies anti-H. pylori and anti-HAV were included in this cross-sectional analysis. Multivariable logistic regression models were used to estimate the odds ratios and 95% confidence intervals for the overall associations of seropositivity to each agent with asthma. Analyses were also stratified by Hispanic/Latino background. Effect modification by smoking status and nativity were tested. An analysis restricted to individuals with spirometry-defined chronic obstructive pulmonary disease (COPD) was also considered.

Results: The weighted overall prevalence of asthma was 16.6%. The weighted seroprevalence of H. pylori was 56.6% and of HAV was 76.6%, and they significantly differed by Hispanic/Latino background. After accounting for age, sex, education and other key confounders, we found no associations between H. pylori or HAV seropositivity with asthma (with and without COPD), either for all individuals combined or for any of the six specific backgrounds. There were no significant interactions by smoking and nativity.

Conclusion: Our findings did not provide support for the role of H. pylori or HAV, as evidence of the hygiene hypothesis in asthma among the large and diverse Hispanic/Latino populations of the HCHS/SOL. Trial registration NCT02060344.

Keywords: Asthma; Helicobacter pylori; Hepatitis A virus; Mexicans; Puerto Ricans.

Conflict of interest statement

Dr. Daviglus reports research grants from the National Institutes of Health (NIH) during the conduct of the study. Dr. Garcia-Bedoya reports grants from NIH/NHLBI during the conduct of the study. Dr. Perreira reports grants from NIH/NHLBI outside the submitted work. Dr. Talavera reports grants and personal fees from NIH/NHLBI during the conduct of the study. The other authors have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Overall and Hispanic/Latino background-specific weighted prevalences of Hepatitis A virus, Helicobacter pylori, asthma and asthma without COPD
Fig. 2
Fig. 2
Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI) for self-reported physician-diagnosed asthma with Helicobacter pylori seropositivity (a) and hepatitis A virus seropositivity (b). ORs adjusted for age, sex, education, nativity, language acculturation, number of missing teeth, doctor’s visits, ferritin, and body mass index. The overall ORs were also adjusted for Hispanic/Latino background

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