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A Population-Based Cohort Study

Janne Schurmann Tolstrup, MSc, PhD; Louise Kristiansen, BSc; Ulrik Becker, MD, DrMedSci; Morten Grønbæk, MD, PhD, DrMedSci

Arch Intern Med. 2009;169(6):603-609.

Background  Alcohol and gallstone disease are the most established risk factors for pancreatitis. Smoking is rarely considered to be a cause despite the fact that a few studies have indicated the opposite. We aimed to assess the independent effects of smoking on the risk of pancreatitis.

Methods  We used data from an observational, population-based cohort study conducted in Denmark. Participants were 9573 women and 8332 men who were followed up for a mean of 20.2 years. Participants underwent a physical examination and completed self-administered questionnaires about lifestyle habits. Information on incident cases of acute and chronic pancreatitis were obtained by record linkage with the Danish national registries.

Results  A total of 235 cases of pancreatitis occurred during follow-up. A dose-response association between smoking and risk of acute and chronic pancreatitis was observed in both men and women. For example, the hazard ratio of developing pancreatitis was 2.6 (95% confidence interval [CI], 1.5-4.7) among women and 2.6 (95% CI, 1.1-6.2) among men who smoked 15 to 24 grams of tobacco per day. Alcohol intake was associated with an increased risk of pancreatitis (hazard ratio, 1.09; 95% CI, 1.04-1.14 for each additional drink per day). The risk of pancreatitis associated with smoking, however, was independent of alcohol and gallstone disease. Approximately 46% of cases of pancreatitis were attributable to smoking in this cohort.

Conclusion  In this population of Danish men and women, smoking was independently associated with increased risk of pancreatitis.

Author Affiliations: Center for Alcohol Research, National Institute of Public Health, University of Southern Denmark (Drs Tolstrup and Grønbæk and Ms Kristiansen), and The Alcohol Unit, Hvidovre Hospital (Dr Becker), Copenhagen, Denmark.

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Arch Intern Med. 2009;169(6):542.
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