Smoking and Inflammatory Bowel Disease: A Comparison of China, India, and the USA

Wang P1, Hu J2,3, Ghadermarzi S4, Raza A5, O'Connell D6, Xiao A7, Ayyaz F8, Zhi M2, Zhang Y2, Parekh NK6, Lazarev M9, Parian A9, Brant SR10, Bedine M9, Truta B9, Hu P2, Banerjee R11, Hutfless SM12,13. Dig Dis Sci. 2018 Jun 4. doi: 10.1007/s10620-018-5142-0. [Epub ahead of print]

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1 Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.

2 Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

3 Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Guangzhou, China.

4 Department of Internal Medicine, East Carolina University, Greenville, NC, USA.

5 Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MD, USA.

6 School of Medicine, Division of Gastroenterology, University of California, Irvine, USA.

7 Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA.

8 Services Institute of Medical Sciences, Lahore, Pakistan.

9 Department of Medicine, Division of Gastroenterology and Hepatology, Meyerhoff Inflammatory Bowel Disease Center, Johns Hopkins University, Baltimore, MD, USA.

10 Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Health, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

11 Asian Institute of Gastroenterology, Hyderabad, India.

12 Division of Gastroenterology and Hepatology, Gastrointestinal Epidemiology Research Center, Johns Hopkins University, 600 N Wolfe St, Blalock 449, Baltimore, MD, 21287, USA. shutfle1@jhmi.edu.

13 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. shutfle1@jhmi.edu.


BACKGROUND: Cigarette smoking is thought to increase the risk of Crohn's disease (CD) and exacerbate the disease course, with opposite roles in ulcerative colitis (UC). However, these findings are from Western populations, and the association between smoking and inflammatory bowel disease (IBD) has not been well studied in Asia.

AIMS: We aimed to compare the prevalence of smoking at diagnosis between IBD cases and controls recruited in China, India, and the USA, and to investigate the impact of smoking on disease outcomes.

METHODS: We recruited IBD cases and controls between 2014 and 2018. All participants completed a questionnaire about demographic characteristics, environmental risk factors and IBD history.

RESULTS: We recruited 337 participants from China, 194 from India, and 645 from the USA. In China, CD cases were less likely than controls to be current smokers (adjusted odds ratio [95% CI] 0.4 [0.2-0.9]). There was no association between current or former smoking and CD in the USA. In China and the USA, UC cases were more likely to be former smokers than controls (China 14.6 [3.3-64.8]; USA 1.8 [1.0-3.3]). In India, both CD and UC had similar current smoking status to controls at diagnosis. Current smoking at diagnosis was significantly associated with greater use of immunosuppressants (4.4 [1.1-18.1]) in CD cases in China.

CONCLUSIONS: We found heterogeneity in the associations of smoking and IBD risk and outcomes between China, India, and the USA. Further study with more adequate sample size and more uniform definition of smoking status is warranted.

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