Background: Serologic screening of gastric cancer (GC) by serum pepsinogens (sPG) levels and Helicobacter pylori (Hp) sero-status, though highly informative, has provided heterogeneous results. Here, we have evaluated the modifying effects of demographic factors on the risk impact of Hp sero-status/sPG levels in gastric cancer, with particular emphasis on age.Methods: A cross-sectional study was carried out on 1341 individuals (GC=578, healthy=763), who were stratified into two age groups: 35-59 years (middle-aged, n=830) and³ 60 years (60 years-plus, n=511). Demographic factors and serological states (Hp sero-staus and sPG levels) were recorded by subject interview and serum ELISAs, respectively. Covariate-specific odds ratios were calculated by multivariable logistic regression.Results: Hp infection was consistently associated with increased sPGI and sPGII levels in the 60 year-plus, but not the middle-aged group. The joint examination of the variable states of the three serum biomarkers (Hp serology, sPGI, and sPGI/II ratio), in the 60 year-plus age group, demonstrated a stepwise escalation of risk from the single (sPGIlow; OR=2.6), to double (sPGI low /sPGI/II low; OR=3.55, and Hppositive /sPGI low; OR=5.0) and ultimately triple (Hp positive /PGI low /PGI/II low; OR=10.48) positive states, in reference to the triple negatives. However, this pattern was not exhibited in the middle-aged subjects.Conclusion: Age was clearly identified as a modifying factor on the risk projection of the combined states of Hp serology and sPG levels in gastric cancer screening, reflected by the augmented (~10.5 fold) risk of GC in the triple positive (Hppositive /sPGI low /sPGI/II low) 60 year-plus subjects, which was not evident in the middle-aged group.