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

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Abstract

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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Acknowledgments

We acknowledge ResearchMatch.org. Part of the recruitment for the study included was done via ResearchMatch, a national health volunteer registry that was created by several academic institutions and supported by the United States National Institutes of Health as part of the Clinical Translational Science Award (CTSA) program. ResearchMatch has a large population of volunteers who have consented to be contacted by researchers about health studies for which they may be eligible. We also acknowledge Girish Ganesh and Kavitha Medaboina for their help in recruiting participants at Asian Institute of Gastroenterology in Hyderabad, India. We acknowledge the grant support from Sun Yat-sen University Clinical Research 5010 Program (2014008), Ludwig-Bayless Science Award, and the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR 001079 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS, or NIH.

Author information

Author notes

  1. Rupa Banerjee and Susan M. Hutfless have contributed equally to this work.

Authors and Affiliations

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

    Peiqi Wang

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

    Jun Hu, Min Zhi, Yuanqi Zhang & Pinjin Hu

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

    Jun Hu

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

    Shadi Ghadermarzi

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

    Ali Raza

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

    Douglas O’Connell & Nimisha K. Parekh

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

    Amy Xiao

  8. Services Institute of Medical Sciences, Lahore, Pakistan

    Faraz Ayyaz

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

    Mark Lazarev, Alyssa Parian, Marshall Bedine & Brindusa Truta

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

    Steven R. Brant

  11. Asian Institute of Gastroenterology, Hyderabad, India

    Rupa Banerjee

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

    Susan M. Hutfless

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

    Susan M. Hutfless

Authors
  1. Peiqi Wang
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  2. Jun Hu
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  8. Min Zhi
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  9. Yuanqi Zhang
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  13. Steven R. Brant
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  14. Marshall Bedine
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  15. Brindusa Truta
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  16. Pinjin Hu
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  17. Rupa Banerjee
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  18. Susan M. Hutfless
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Corresponding author

Correspondence to Susan M. Hutfless.

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No authors have conflict of interest with relation to this study.

Appendix

Appendix

See Tables 2, 3.

Table 2 The prevalence of ever exposure to passive smoking and its association with Crohn’s disease and ulcerative colitis
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Table 3 The distribution of cumulative packs of cigarettes smoked at diagnosis and its association with Crohn’s disease and ulcerative colitis by country of recruitment
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Wang, P., Hu, J., Ghadermarzi, S. et al. Smoking and Inflammatory Bowel Disease: A Comparison of China, India, and the USA. Dig Dis Sci 63, 2703–2713 (2018). https://doi.org/10.1007/s10620-018-5142-0

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  • DOI: https://doi.org/10.1007/s10620-018-5142-0

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