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Burden and correlates of multiple chronic infections and their associations with cancer incidence in Chinese adults: a large nested case-cohort study

Abstract:
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.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1002/ijc.70555

Authors

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Institution:
University of Oxford
Division:
MSD
Department:
Nuffield Department of Population Health
Sub department:
Clinical Trial Service Unit
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Nuffield Department of Population Health
Sub department:
Clinical Trial Service Unit
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Nuffield Department of Population Health
Sub department:
Clinical Trial Service Unit
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Nuffield Department of Population Health
Sub department:
Clinical Trial Service Unit
Role:
Author

Contributors


More from this funder
Funder identifier:
https://ror.org/027s68j25
Grant:
2023ZD0510100
2023ZD0510101
Programme:
Noncommunicable Chronic Diseases National Science and Technology Major Project
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Funder identifier:
https://ror.org/01h0zpd94
Grant:
82388102
More from this funder
Funder identifier:
https://ror.org/054225q67
Grant:
C16077/A29186
C500/A16896
More from this funder
Funder identifier:
https://ror.org/02wdwnk04
Grant:
CH/1996001/9454
More from this funder
Funder identifier:
https://ror.org/03x94j517
Grant:
MC_U137686851
MC_UU_00017/1
MC_UU_12026/2


Publisher:
Wiley
Journal:
International Journal of Cancer More from this journal
Pages:
1-14
Publication date:
2026-05-18
Acceptance date:
2026-04-28
DOI:
EISSN:
1097-0215
ISSN:
0020-7136


Language:
English
Keywords:
Pubs id:
2412775
Local pid:
pubs:2412775
Deposit date:
2026-04-30
ARK identifier:

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