Lifetime smoking history and cohort-based smoking prevalence in chronic pancreatitis

Abstract

Background/objective: Smoking prevalence in patients with chronic pancreatitis [CP] is high. We aimed to understand lifetime history of smoking and cohort trends in CP patients to inform effective strategies for smoking cessation.

Method: Data on 317 CP patients from the North American Pancreatitis Study 2 [NAPS2] Continuation and Validation Study and the NAPS2 Ancillary Study were analyzed. Smoking history was assessed for each phase of life from the onset of smoking to study enrollment. Data on second-hand smoke and drinking history were also collected. We compared demographic factors, drinking history, pain level and pancreas morphology by smoking status at age 25 (non-smoking, <1 pack per day [PPD], ≥1 PPD). We compared smoking prevalence by birth cohorts: 1930-1949, 1950-1969, 1970-1989.

Result: Fifty-one percent of CP patients reported smoking at the time of enrollment. Those who smoked ≥1 PPD at age 25 smoked a cumulative total of 30.3 pack-years of cigarettes over a lifetime. Smoking at age 25 was associated with greater lifetime drinking and greater exposure to second-hand smoke at home and at workplace. Pancreatic atrophy and pseudocysts were more common among smokers. Pancreatic pain was more severe among smokers, and 12-13% of smokers reported smoking to alleviate pain. Male CP patients born in 1950-1969 reported the highest peak prevalence of smoking, and female CP patients born in 1970-1989 reported highest peak prevalence of smoking.

Conclusion: CP patients exhibit intense and sustained smoking behavior once established in the 20s. Regardless, cohort analyses demonstrate that the behaviors could potentially be altered by policy changes.

Keywords: Chronic Pancreatitis; Cohort; Epidemiology; Smoking.

Figure 1.. Component bar diagram of individual smoking trajectory in chronic pancreatitis patients by alcohol etiology, Male (A) and Female (B).

Each bar represents smoking trajectory in each participant with the length of the colored bars indicating the duration of smoking at that colored intensity. Gray bars indicate periods of non-smoking, green bars indicate periods of smoking ≤5 cigarettes/day, yellow bars indicate smoking 6-10 cigarettes/day, orange bars indicate smoking 11-20 cigarettes/day and red bars indicate smoking more than 20 cigarettes/day. Bars end at age of CP diagnosis.

Figure 2.

Prevalence of smoking by age in three birth cohorts of chronic pancreatitis patients from 1930 to 1989, Male (A) and Female (B)