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‘Smoker’s paradox’ found in study of IBD patients



– Smoking is more prevalent in Crohn’s disease (CD) patients than in patients with ulcerative colitis (UC), results from a retrospective analysis of national data showed. In addition, smoking status was associated with favorable outcomes in mortality, routine discharges, length of stay, and cost of care, a so-called “smoker’s paradox.”

“This paradox seems to be real, because we know that it has been shown in some heart diseases, that the patients who were smokers had better outcomes,” Zubair Khan, MD, said in an interview at the Crohn’s & Colitis Congress, a partnership of the Crohn’s & Colitis Foundation and the American Gastroenterological Association. In fact, a recent analysis of a nationwide cohort of patients who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction found that smokers had significantly lower risk‐adjusted in‐hospital mortality, compared with nonsmokers (J Am Heart Assoc. 2016 Apr 22;5:e003370. doi: 10.1161/JAHA.116.003370).

Male hand holding a lit cigarette ricky_68fr/fotolia
In an effort to analyze smoking trends in patients with UC and CD and their impact on outcomes, Dr. Khan, associate chief resident in the internal medicine department at the University of Toledo (Ohio) Medical Center and his associates analyzed the National Inpatient Sample database for all subjects who had a primary or secondary discharge diagnosis of inflammatory bowel disease (IBD) during 2002-2014. Next, they used ICD-9 codes to identify both current and former smokers.

Between 2002 and 2014, a higher proportion of CD patients than UC patients were smokers (25.1% vs. 17.2%; P less than .001), while CD patients who smoked were more likely to be younger than age 50 years, compared with UC patients who smoked (53.9% vs. 36.9%; P less than .001). The researchers also found that African Americans with CD were more likely than were those with UC to smoke (10% vs. 7.8%, respectively; P less than .001). On the other hand, both Hispanics and Asians with UC were more likely to be smokers than were their counterparts with CD (5% vs. 2.9% and 3.4% vs. 2.5%, respectively). From a geographical standpoint, UC patients in the Northeast and Western United States were more likely to be smokers, compared with CD patients in those regions (20.7% vs. 18.3% and 21.4% vs. 15%, respectively). Meanwhile, CD patients in the Midwest and South were more likely to be smokers, compared with UC patients in those regions (29.3% vs 26% and 37.2% vs. 31.9%, respectively).

Dr. Khan and his associates also found that a higher proportion of female CD patients were smokers, compared with female UC patients (57% vs. 47.3%; P less than .001), and that mortality among UC and CD patients with no smoking history was higher than that of their counterparts who had a smoking history (2.5% vs. 1.2% and 1.2% vs. 0.7%, respectively; P less than .001 for both associations).

“I would certainly not encourage IBD patients to smoke, but maybe we need to so some more prospective studies to better understand this smoker’s paradox,” Dr. Khan said. He reported having no financial disclosures.

*This story was updated on 3/26.

SOURCE: Khan et al. Crohn’s & Colitis Congress, Poster 213.

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