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. 2022 Aug 4;16(7):1030-1038.
doi: 10.1093/ecco-jcc/jjac015.

Smoking Behaviour Changes After Diagnosis of Inflammatory Bowel Disease and Risk of All-cause Mortality

Xinwei Hua  1   2 , Emily W Lopes  1   2 , Kristin E Burke  1   2 , Ashwin N Ananthakrishnan  1   2 , James M Richter  1 , Chun-Han Lo  1   3 , Paul Lochhead  1   2 , Andrew T Chan  1   2   4 , Hamed Khalili  1   2   5   6
Affiliations

Smoking Behaviour Changes After Diagnosis of Inflammatory Bowel Disease and Risk of All-cause Mortality

Xinwei Hua et al. J Crohns Colitis. .

Abstract

Background and aims: We examined smoking behaviour changes after diagnoses of Crohn's disease [CD] and ulcerative colitis [UC] and evaluated their impact on mortality.

Methods: Study population included incident CD or UC cases from three cohorts of the Nurses' Health Study [NHS], NHSII, and Health Professionals Follow-up Study. Smoking and other risk factors were prospectively assessed. Smoking behaviour changes were categorised as never, former [i.e., quit smoking before diagnosis], quitters [i.e., quit smoking after diagnosis], and current [i.e., continue smoking after diagnosis]. Follow-up for date and cause of death was completed through linkage to the National Death Index. Cox proportional hazard regression was used to estimate hazard ratios [HRs] and 95% confidence intervals [CIs].

Results: Among 909 eligible CD and UC cases, 45% were never smokers, 38% were past smokers, and 16% were active smokers at the time of diagnosis. Among active smokers, 70% of patients with CD and 44% of patients with UC continued to smoke after diagnosis. In patients with CD, compared with current smokers, the multivariable-adjusted HRs [95% CI] of death were 0.19 [0.10 to 0.38] for never smokers, 0.31 [0.16 to 0.57] for former smokers, and 0.41 [0.18 to 0.93] for quitters. Similarly for UC, compared with current smokers, we observed a reduced risk of mortality for never smokers [HR = 0.23, 95% CI 0.10 to 0.51], former smokers [HR = 0.23, 95% CI 0.11 to 0.48], and quitters [HR = 0.28, 95% CI 0.11 to 0.72].

Conclusions: In three cohorts of health professionals, a substantial proportion of patients with new diagnosis of CD and UC and history of smoking continued to smoke after diagnosis. Smoking cessation around the time of diagnosis was associated with a significant reduction in mortality.

Keywords: Inflammatory bowel disease; behaviour change; mortality; smoking.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
The flow diagram of eligible participants in the study. NHS, Nurses’ Health Study; HPFS, Health Professionals Follow-up Study; IBD, inflammatory bowel diseases; BMI, body mass index. *Restricted date of diagnosis to ensure each patient had two questionnaire cycles before and two after diagnosis.
Figure 2.
Figure 2.
Changes in smoking behaviour from pre- to post-diagnosis period among patients with Crohn’s disease [CD] and ulcerative colitis [UC], n [%].
See this image and copyright information in PMC

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