{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:08:39Z","timestamp":1788865719694,"version":"build-2803163510"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Helicobacter"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n In February 2013, Japanese national health insurance coverage for\n \n Helicobacter pylori<\/jats:italic>\n <\/jats:styled-content>\n eradication was expanded to patients with\n \n H.\u2009pylori<\/jats:italic>\n <\/jats:styled-content>\n \u2010positive, endoscopically diagnosed chronic gastritis. This policy broadened access to eradication treatment, but its relationship with subsequent population\u2010level gastric cancer trends requires cautious interpretation.\n <\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n To describe national trends in gastric cancer mortality and incidence before and after the 2013 insurance expansion, with attention to age\u2010specific patterns, endoscopic screening, treatment uptake, and alternative explanations.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We examined publicly available national mortality data from the Ministry of Health, Labour and Welfare and cancer incidence data from the National Cancer Center. Calendar\u2010year trends in annual gastric cancer deaths, incident cases, and age\u2010specific deaths were evaluated descriptively. The 2013 policy change was treated as a major contextual event rather than as a causal intervention with an internally estimated counterfactual.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Annual gastric cancer deaths declined from 48,427 in 2013 to 37,394 in 2024, a 25.2% reduction in crude annual deaths. Incidence also decreased after a later peak, with available national incidence data showing fewer new cases by 2021. Age\u2010specific analyses showed pronounced decreases in deaths among people younger than 80\u2009years, whereas deaths among those aged 80\u2009years or older continued to increase.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n After the 2013 expansion of insurance coverage for\n \n H.\u2009pylori<\/jats:italic>\n <\/jats:styled-content>\n eradication, gastric cancer mortality and incidence in Japan declined at the population level. These ecological trends are compatible with a contribution from increased eradication therapy and endoscopy\u2010linked detection, but causality cannot be established from aggregate data alone. Age\u2010standardized, claims\u2010linked, stage\u2010specific, and treatment\u2010linked analyses are needed to quantify the independent policy effect.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/hel.70162","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:25:31Z","timestamp":1788863131000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Population\u2010Level Trends in Gastric Cancer Mortality and Incidence After Expansion of Japanese National Health Insurance Coverage for\n \n Helicobacter pylori<\/i>\n <\/scp>\n Eradication: A Descriptive Time\u2010Trend Study"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7768-3434","authenticated-orcid":false,"given":"Masahiro","family":"Asaka","sequence":"first","affiliation":[{"name":"Caress Memorial Hospital Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tokuma","family":"Tanuma","sequence":"additional","affiliation":[{"name":"Caress Memorial Hospital Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5200-4300","authenticated-orcid":false,"given":"Akiko","family":"Kowada","sequence":"additional","affiliation":[{"name":"Department of Occupational Health Kitasato University Graduate School of Medical Sciences Sagamihara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9774-4513","authenticated-orcid":false,"given":"Shouji","family":"Matsushima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Kyushu University Graduate School of Medicine Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kozo","family":"Akino","sequence":"additional","affiliation":[{"name":"Member of the House of Councilors Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"3020","DOI":"10.1038\/s41591-025-03793-6","article-title":"Global Lifetime Estimates of Expected and Preventable Gastric Cancers Across 185 Countries","volume":"31","author":"Park J. Y.","year":"2024","journal-title":"Nature Medicine"},{"key":"e_1_2_10_3_1","volume-title":"Helicobacter pylori Eradication as a Strategy for Preventing Gastric Cancer. IARC Working Group Reports, Volume 8","author":"IARC Working Group","year":"2014"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/S0140-6736(08)61159-9","article-title":"Effect of Eradication of \n Helicobacter pylori\n on Incidence of Metachronous Gastric Carcinoma After Endoscopic Resection of Early Gastric Cancer: An Open\u2010Label, Randomised Controlled Trial","volume":"372","author":"Fukase K.","year":"2008","journal-title":"Lancet"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","DOI":"10.1111\/hel.12415","article-title":"Effect on \n Helicobacter pylori\n Eradication Therapy Against Gastric Cancer in Japan","volume":"22","author":"Tsuda M.","year":"2017","journal-title":"Helicobacter"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s00535-021-01769-0","article-title":"Evidence\u2010Based Clinical Practice Guidelines for Peptic Ulcer Disease 2020","volume":"56","author":"Kamada T.","year":"2021","journal-title":"Journal of Gastroenterology"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-015855","article-title":"Impact of Health Insurance Coverage for \n Helicobacter pylori\n Eradication Therapy on the Prevalence of Infection in Japan","volume":"7","author":"Hiroi S.","year":"2017","journal-title":"BMJ Open"},{"key":"e_1_2_10_8_1","article-title":"Changes in Prevalence of \n Helicobacter pylori\n in Japan: A Population\u2010Based Study","volume":"12","author":"Abiko S.","year":"2022","journal-title":"BMJ Open"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","DOI":"10.1111\/hel.12886","article-title":"Economic and Health Impacts of \n Helicobacter pylori\n Eradication Strategy for the Treatment of Peptic Ulcer Disease: A Cost\u2010Effectiveness Analysis","volume":"27","author":"Kowada A.","year":"2022","journal-title":"Helicobacter"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","DOI":"10.1111\/hel.12988","article-title":"An Increasing Trend of Gastric Cancer Deaths and Inadequate Preventive Measures in Elderly Adults","volume":"28","author":"Matsushima R.","year":"2023","journal-title":"Helicobacter"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"3845","DOI":"10.1111\/cas.14586","article-title":"Gastric Cancer Deaths by Age Group in Japan: Outlook on Preventive Measures for Elderly Adults","volume":"111","author":"Asaka M.","year":"2020","journal-title":"Cancer Science"},{"key":"e_1_2_10_12_1","volume-title":"Cancer Statistics in Japan","author":"National Cancer Center Japan","year":"2026"},{"key":"e_1_2_10_13_1","volume-title":"Population\u2010Based Helicobacter pylori Screen\u2010and\u2010Treat Strategies for Gastric Cancer Prevention: Guidance on Implementation. IARC Working Group Reports, Volume 12","author":"IARC Working Group","year":"2025"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1002\/ijc.21810","article-title":"High Salt Diets Dose\u2010Dependently Promote Gastric Chemical Carcinogenesis in \n Helicobacter pylori\n \u2010Infected Mongolian Gerbils","volume":"119","author":"Kato S.","year":"2006","journal-title":"International Journal of Cancer"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1136\/gutjnl-2022-327745","article-title":"Management of \n Helicobacter pylori\n Infection: The Maastricht VI\/Florence Consensus Report","volume":"71","author":"Malfertheiner P.","year":"2022","journal-title":"Gut"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1136\/gutjnl-2015-309252","article-title":"Kyoto Global Consensus Report on \n Helicobacter pylori\n Gastritis","volume":"64","author":"Sugano K.","year":"2015","journal-title":"Gut"},{"key":"e_1_2_10_17_1","first-page":"871","article-title":"Vonoprazan\u2010Based Triple Therapy Is Effective for \n Helicobacter pylori\n Eradication","volume":"51","author":"Murakami K.","year":"2016","journal-title":"Journal of Gastroenterology"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1056\/NEJMsb2515372","article-title":"Helicobacter pylori\n Screen\u2010and\u2010Treat Programs for Gastric Cancer Prevention: IARC Working Group Report","volume":"394","author":"Park J. Y.","year":"2026","journal-title":"New England Journal of Medicine"}],"container-title":["Helicobacter"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hel.70162","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hel.70162","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hel.70162","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:25:34Z","timestamp":1788863134000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hel.70162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/hel.70162"],"URL":"https:\/\/doi.org\/10.1111\/hel.70162","archive":["Portico"],"relation":{},"ISSN":["1083-4389","1523-5378"],"issn-type":[{"value":"1083-4389","type":"print"},{"value":"1523-5378","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-06-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70162"}}