Burden and Correlates of Multiple Chronic Infections and Their Associations With Cancer Incidence in Chinese Adults: A Large Case-Cohort Study.

Yang L., Clarke J., Kröller L., Kartsonaki C., Fry H., Jeske R., Gordon A., Clark S., Hill M., Avery D., Chen Y., Du H., Lv J., Sun D., Yu C., Li L., Millwood IY., Waterboer T., Chen Z., China Kadoorie Biobank Collaborative Group .

Several oncogenic pathogens cause specific cancers, but uncertainties remain about many other chronic infections, combined pathogen effects and evidence from non-European populations. We conducted a case-cohort study of ~30,000 site-specific incident cancer cases and > 8000 subcohort participants nested within the China Kadoorie Biobank. Baseline plasma was assayed for IgG antibodies against 47 antigens from 20 pathogens (16 viruses, 3 bacteria, 1 parasite) using an Automated Multiplex Serology assay. We described seroprevalence by age, sex, areas and lifestyle factors; estimated adjusted odd ratios for correlates of pathogen seropositivity in the subcohort using multivariable logistic regression and adjusted hazard ratios for overall and selected cancers using Prentice-weighted Cox models. Among subcohort participants, seroprevalence for most pathogens varied and was significantly associated with sex, region and birth cohort. Participants were seropositive for a mean of ~10 pathogens. Compared with seronegative participants, those seropositive for seven pathogens had significantly higher overall cancer risk, particularly for HCV (HR = 2.18, 95% CI: 1.90-2.49), CMV (1.23, 1.08-1.40) and HSV-2 (1.14, 1.09-1.18) and HPV-16 oncogenes (e.g., E6: 1.57, 1.40-1.75). Lower risks were observed for HSV-1 (0.88, 0.81-0.95) and among those with fewer co-infections. There were expected positive associations of liver cancer with HBV (2.29, 2.06-2.54) and HCV (7.05, 4.31-11.54) and of stomach cancer with H. pylori (1.91, 1.68-2.17). In Chinese adults, multiple chronic infections were associated with risk of overall and certain selected cancers. Further research is warranted to investigate pathogen-specific and co-infection-related risks of site-specific cancers.

DOI

10.1002/ijc.70555

Type

Journal article

Publication Date

2026-05-18T00:00:00+00:00

Keywords

automated multiplex serology, cancer, chronic infection, prospective study, relative risk

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