Burden and correlates of multiple chronic infections and their associations with cancer incidence in Chinese adults: a large nested 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.

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 nested case-cohort study of ~30,000 site-specific incident cancer cases and >8,000 subcohort participants 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.

Type

Journal article

Publisher

Wiley

Publication Date

2026-04-30T00:00:00+00:00

Keywords

chronic infection, cancer, Automated Multiplex Serology, prospective study, seroprevalence, relative risk, China

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