{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T04:18:45Z","timestamp":1775276325876,"version":"3.50.1"},"reference-count":50,"publisher":"BMJ","issue":"10","funder":[{"name":"Associazione Italiana per la Ricerca sul Cancro","award":["21378"],"award-info":[{"award-number":["21378"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2022,6,25]]},"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Peptic ulcer disease (PUD) and gastric cancer (GC) are more prevalent in individuals with low socioeconomic status (SES) and share several risk factors. The aim of this study was to investigate the mediating role of PUD in the association between established risk factors and GC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a pooled analysis of 12 studies from the Stomach Cancer Pooling Project Consortium, including a total of 4877 GC cases and 11\u2009808 controls. We explored the mediating role of PUD in the association between SES, tobacco smoking, heavy alcohol drinking and salt intake, and GC. Also, we assessed the ORs and 95% CIs of the risk factors and both PUD and GC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>PUD mediated 36% of the smoking effect mainly among men. Other risk factors were only slightly mediated by PUD (SES, 5.3%; heavy alcohol drinking, 3.3%; and salt intake, 2.5%). No significant difference was found when excluding PUD diagnosed within 2 years from GC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our study provides innovative information on the mechanism of stomach mucosal damage leading to PUD and GC, with respect to the effect of tobacco smoking in particular.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2022-219074","type":"journal-article","created":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T13:22:49Z","timestamp":1657718569000},"page":"861-866","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Peptic ulcer as mediator of the association between risk of gastric cancer and socioeconomic status, tobacco smoking, alcohol drinking and salt intake"],"prefix":"10.1136","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2309-7365","authenticated-orcid":false,"given":"Giulia","family":"Collatuzzo","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"}]},{"given":"Gianfranco","family":"Alicandro","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation, Universit\u00e0 degli Studi di Milano, Milano, Italy"},{"name":"Cystic Fibrosis Center, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"}]},{"given":"Paola","family":"Bertuccio","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology \u201cG.A. Maccacaro\u201d, Universit\u00e0 degli Studi di Milano, Milan, Italy"},{"name":"Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy"}]},{"given":"Claudio","family":"Pelucchi","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology \u201cG.A. Maccacaro\u201d, Universit\u00e0 degli Studi di Milano, Milan, Italy"}]},{"given":"Rossella","family":"Bonzi","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology \u201cG.A. Maccacaro\u201d, Universit\u00e0 degli Studi di Milano, Milan, Italy"}]},{"given":"Domenico","family":"Palli","sequence":"additional","affiliation":[{"name":"Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO, Florence, Italy"}]},{"given":"Monica","family":"Ferraroni","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology \u201cG.A. Maccacaro\u201d, Universit\u00e0 degli Studi di Milano, Milan, Italy"}]},{"given":"Weimin","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}]},{"given":"Amelie","family":"Plymoth","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}]},{"given":"David","family":"Zaridze","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia"}]},{"given":"Dmitry","family":"Maximovich","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia"}]},{"given":"Nuria","family":"Aragones","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain"},{"name":"Cancer Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain"}]},{"given":"Gemma","family":"Casta\u00f1o-Vinyals","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain"},{"name":"Barcelona Institute for Global Health\u2014ISGlobal, Barcelona, Spain"},{"name":"IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain"},{"name":"Universitat Pompeu Fabra (UPF), Barcelona, Spain"}]},{"given":"Jesus","family":"Vioque","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria y Biom\u00e9dica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), Alicante, Spain"}]},{"given":"Manoli","family":"Garcia de la Hera","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria y Biom\u00e9dica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), Alicante, Spain"}]},{"given":"Zuo-Feng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA"}]},{"given":"Jinfu","family":"Hu","sequence":"additional","affiliation":[{"name":"Harbin Medical University, Harbin, People's Republic of China"}]},{"given":"Lizbeth","family":"Lopez-Carrillo","sequence":"additional","affiliation":[{"name":"Mexico National Institute of Public Health, Morelos, Mexico"}]},{"given":"Malaqu\u00edas","family":"L\u00f3pez-Cervantes","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, UNAM. Coyoac\u00e1n, Mexico"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8764-9299","authenticated-orcid":false,"given":"Michela","family":"Dalmartello","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology \u201cG.A. Maccacaro\u201d, Universit\u00e0 degli Studi di Milano, Milan, Italy"}]},{"given":"Lina","family":"Mu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA"}]},{"given":"Mary H","family":"Ward","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA"}]},{"given":"Charles","family":"Rabkin","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA"}]},{"given":"Guo-Pei","family":"Yu","sequence":"additional","affiliation":[{"name":"Medical Informatics Center, Peking University, Peking, People's Republic of China"}]},{"given":"M Constanza","family":"Camargo","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8172-2483","authenticated-orcid":false,"given":"Maria Paula","family":"Curado","sequence":"additional","affiliation":[{"name":"Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, S\u00e3o Paulo, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1870-1430","authenticated-orcid":false,"given":"Nuno","family":"Lunet","sequence":"additional","affiliation":[{"name":"EPIUnit \u2013 Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Porto, Portugal"},{"name":"Laborat\u00f3rio para a Investiga\u00e7\u00e3o Integrativa e Translacional em Sa\u00fade Populacional (ITR), Porto, Portugal"},{"name":"Departamento de Ci\u00eancias da Sa\u00fade P\u00fablica e Forenses e Educa\u00e7\u00e3o M\u00e9dica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal"}]},{"given":"Eva","family":"Negri","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"},{"name":"Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology \u201cG.A. Maccacaro\u201d, Universit\u00e0 degli Studi di Milano, Milan, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1441-897X","authenticated-orcid":false,"given":"Carlo","family":"La Vecchia","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology \u201cG.A. Maccacaro\u201d, Universit\u00e0 degli Studi di Milano, Milan, Italy"}]},{"given":"Paolo","family":"Boffetta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"},{"name":"Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA"}]}],"member":"239","published-online":{"date-parts":[[2022,7,13]]},"reference":[{"key":"2025100300425429000_76.10.861.1","doi-asserted-by":"crossref","first-page":"6695","DOI":"10.7150\/jca.62734","article-title":"Global changing trends in incidence and mortality of gastric cancer by age and sex, 1990-2019: findings from global burden of disease study","volume":"12","author":"Zhang","year":"2021","journal-title":"J Cancer"},{"key":"2025100300425429000_76.10.861.2","first-page":"209","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA A Cancer J Clin"},{"key":"2025100300425429000_76.10.861.3","first-page":"82","article-title":"Epidemiology of gastric cancer and risk factors","volume":"89","author":"Cavatorta","year":"2018","journal-title":"Acta Biomed"},{"key":"2025100300425429000_76.10.861.4","doi-asserted-by":"publisher","DOI":"10.1097\/CEJ.0000000000000480"},{"key":"2025100300425429000_76.10.861.5","doi-asserted-by":"crossref","unstructured":"Alicandro G , Bertuccio P , Collatuzzo G , et al . The mediating role of combined lifestyle factors on the relationship between education and gastric cancer in the stomach cancer pooling (stop) project. Br J Cancer;29.doi:10.1038\/s41416-022-01857-9","DOI":"10.1038\/s41416-022-01857-9"},{"key":"2025100300425429000_76.10.861.6","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/S0140-6736(16)32404-7","article-title":"Peptic ulcer disease","volume":"390","author":"Lanas","year":"2017","journal-title":"The Lancet"},{"key":"2025100300425429000_76.10.861.7","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/MCG.0b013e3180318ac5","article-title":"Risk factors of peptic ulcer in 4943 inpatients","volume":"42","author":"Talamini","year":"2008","journal-title":"J Clin Gastroenterol"},{"key":"2025100300425429000_76.10.861.8","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1177\/000313481908500948","article-title":"Statewide analysis of peptic ulcer disease: as hospitalizations decrease, procedural volume remains steady","volume":"85","author":"Howley","year":"2019","journal-title":"Am Surg"},{"key":"2025100300425429000_76.10.861.9","doi-asserted-by":"crossref","first-page":"2950","DOI":"10.1111\/j.1572-0241.2002.07068.x","article-title":"Management of peptic ulcer disease not related to Helicobacter pylori or NSAIDs","volume":"97","author":"Quan","year":"2002","journal-title":"Am J Gastroenterol"},{"key":"2025100300425429000_76.10.861.10","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.cgh.2014.07.043","article-title":"A tool to predict risk for gastric cancer in patients with peptic ulcer disease on the basis of a nationwide cohort","volume":"13","author":"Lee","year":"2015","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025100300425429000_76.10.861.11","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.amjsurg.2018.08.025","article-title":"Disparities in peptic ulcer disease: a nationwide study","volume":"216","author":"Havens","year":"2018","journal-title":"Am J Surg"},{"key":"2025100300425429000_76.10.861.12","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1002\/bjs.9329","article-title":"Global disease burden of conditions requiring emergency surgery","volume":"101","author":"Stewart","year":"2013","journal-title":"Br J Surg"},{"key":"2025100300425429000_76.10.861.13","doi-asserted-by":"publisher","DOI":"10.1097\/CEJ.0000000000000017"},{"key":"2025100300425429000_76.10.861.14","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1097\/00008469-199512000-00005","article-title":"Nitrosamine intake and gastric cancer risk","volume":"4","author":"La Vecchia","year":"1995","journal-title":"Eur J Cancer Prev"},{"key":"2025100300425429000_76.10.861.15","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/CEJ.0b013e328330eb1a","article-title":"Is temperature an effect modifier of the association between green tea intake and gastric cancer risk?","volume":"19","author":"Deandrea","year":"2010","journal-title":"Eur J Cancer Prev"},{"key":"2025100300425429000_76.10.861.16","doi-asserted-by":"publisher","DOI":"10.1080\/01635580802054512"},{"key":"2025100300425429000_76.10.861.17","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.2910440409"},{"key":"2025100300425429000_76.10.861.18","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.21137"},{"key":"2025100300425429000_76.10.861.19","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0215(19990812)82:4<473::AID-IJC1>3.0.CO;2-K"},{"key":"2025100300425429000_76.10.861.20","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.1231"},{"key":"2025100300425429000_76.10.861.21","first-page":"501","article-title":"Population-based multicase-control study in common tumors in Spain (MCC-Spain): rationale and study design. Gac Sanit. 2015;29:308-15","volume":"32","author":"Casta\u00f1o-Vinyals","year":"2018","journal-title":"Erratum in: Gac Sanit"},{"key":"2025100300425429000_76.10.861.22","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0215(19991008)83:2<223::AID-IJC13>3.0.CO;2-M"},{"key":"2025100300425429000_76.10.861.23","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2011-100071"},{"key":"2025100300425429000_76.10.861.24","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.11195"},{"key":"2025100300425429000_76.10.861.25","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0215(19970328)71:1<14::AID-IJC4>3.0.CO;2-6"},{"key":"2025100300425429000_76.10.861.26","doi-asserted-by":"publisher","DOI":"10.4310\/SII.2009.v2.n4.a7"},{"key":"2025100300425429000_76.10.861.27","unstructured":"Emsley R , Liu H . PARAMED: Stata module to perform causal mediation analysis using parametric regression models. statistical software components. Boston: Boston College Department of Economics, 2013."},{"key":"2025100300425429000_76.10.861.28","unstructured":"De Martel C , Parsonnet J , Cancer S , et al . Cancer epidemiology and prevention. New York, NY: Oxford University Press, 2018."},{"key":"2025100300425429000_76.10.861.29","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1056\/NEJM199607253350404","article-title":"The risk of stomach cancer in patients with gastric or duodenal ulcer disease","volume":"335","author":"Hansson","year":"1996","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025100300425429000_76.10.861.30","doi-asserted-by":"publisher","DOI":"10.1136\/gut.40.2.247"},{"key":"2025100300425429000_76.10.861.31","unstructured":"Kogevinas M , Pearce N , Susser M , et al , eds. Social Inequalities and Cancer. IARC Scientific Publication No. 138. Lyon, France: IARC, 1997."},{"key":"2025100300425429000_76.10.861.32","first-page":"997","article-title":"Educational inequality in cancer mortality: a record linkage study of over 35 million Italians","volume":"28","author":"Alicandro","year":"2017","journal-title":"Cancer Causes Control"},{"key":"2025100300425429000_76.10.861.33","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.32298"},{"key":"2025100300425429000_76.10.861.34","doi-asserted-by":"publisher","DOI":"10.1006\/pmed.2002.1064"},{"key":"2025100300425429000_76.10.861.35","doi-asserted-by":"publisher","DOI":"10.1136\/gut.35.6.742"},{"key":"2025100300425429000_76.10.861.36","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2018.00074","article-title":"Impact of Cigarette Smoking on the Gastrointestinal Tract Inflammation: Opposing Effects in Crohn\u2019s Disease and Ulcerative Colitis","volume":"9","author":"Berkowitz","year":"2018","journal-title":"Front Immunol"},{"key":"2025100300425429000_76.10.861.37","doi-asserted-by":"publisher","DOI":"10.1023\/A:1026040723669"},{"key":"2025100300425429000_76.10.861.38","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.30891"},{"key":"2025100300425429000_76.10.861.39","doi-asserted-by":"publisher","DOI":"10.1136\/gut.52.2.186"},{"key":"2025100300425429000_76.10.861.40","doi-asserted-by":"publisher","DOI":"10.1159\/000090167"},{"key":"2025100300425429000_76.10.861.41","first-page":"1523","article-title":"Dietary salt and gastric ulcer. Gut. 1986;27:1138-42","volume":"27","author":"Sonnenberg","year":"1986","journal-title":"Erratum in: Gut"},{"key":"2025100300425429000_76.10.861.42","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1093\/jnci\/58.1.13","article-title":"Epidemiologic pathology of gastric ulcer and gastric carcinoma among Japanese in Hawaii2","volume":"58","author":"Stemmermann","year":"1977","journal-title":"J Natl Cancer Inst"},{"key":"2025100300425429000_76.10.861.43","unstructured":". Available: https:\/\/www.wcrf.org\/wp-content\/uploads\/2021\/01\/CUP-Strong-Evidence-Matrix.pdf"},{"key":"2025100300425429000_76.10.861.44","doi-asserted-by":"publisher","DOI":"10.1128\/JB.01728-07"},{"key":"2025100300425429000_76.10.861.45","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1159\/000357855","article-title":"Gastric barrier function and toxic damage","volume":"32","author":"Niv","year":"2014","journal-title":"Dig Dis"},{"key":"2025100300425429000_76.10.861.46","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/155.11.1054"},{"key":"2025100300425429000_76.10.861.47","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.21810"},{"key":"2025100300425429000_76.10.861.48","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-06-4746"},{"key":"2025100300425429000_76.10.861.49","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.epirev.a018040"},{"key":"2025100300425429000_76.10.861.50","doi-asserted-by":"crossref","unstructured":"Yu J , Yang P , Qin X , et al . Impact of smoking on the eradication of Helicobacter pylori. Helicobacter 2021:e12860.","DOI":"10.1111\/hel.12860"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2022-219074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T07:43:08Z","timestamp":1759477388000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2022-219074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,13]]},"references-count":50,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,9,9]]},"published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1136\/jech-2022-219074"],"URL":"https:\/\/doi.org\/10.1136\/jech-2022-219074","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,13]]}}}