Smoking Increases Risk for Acute Pancreatitis in a Dose-Dependent Pattern

Smoking increased the risk for acute pancreatitis in a dose-dependent manner among a Korean population.

Smoking significantly increases risk for acute pancreatitis based on smoking amount, duration, and changes in smoking habits, according to study findings published in the Journal of Gastroenterology and Hepatology.

Researchers in South Korea conducted a population-based cohort study using data from the Korean Health Examination database and the Korean National Health Insurance Services claims database. Researchers analyzed the relationship between smoking status, changes in smoking habits, and incidence of acute pancreatitis.

The study tracked health outcomes in patients who underwent health examinations in 2009 and 2011 until December 31, 2018 or until they received an ICD-10 diagnosis of acute pancreatitis. The median observation period was 6.38 years.

Risk for Acute Pancreatitis Based on Smoking Status

Researchers classified 3,864,227 individuals into 3 groups based on completed questionnaires on smoking status for health examinations conducted in 2009 and 2011: 2,333,297 people who never smoked, 535,970 ex-smokers, and 994,960 current smokers. Researchers subdivided the smoker groups by amount of smoking (<10, 10-19, or ≥20 cigarettes/day) and smoking duration (<10, 10-29, or ≥30 years).

Current smokers tended to be younger, male, and heavier drinkers. Ex-smokers tended to be male and heavier drinkers. Ex-smokers also had more comorbidities, such as hypertension, diabetes, dyslipidemia, gallstones, and chronic pancreatitis.

Compared with never-smokers, current smokers demonstrated a significantly higher risk for developing acute pancreatitis (hazard ratio [HR], 1.78, 95% CI, 1.70-1.87). Even after adjusting for variables that might have influenced risk, such as age, sex, physical exercise, comorbidities, and drinking status, current smokers still had a higher risk for acute pancreatitis (HR, 1.51; 95% CI, 1.42-1.61).

Risk for acute pancreatitis increased commensurately as smoking amount increased among current smokers. Compared to never-smokers, risk for acute pancreatitis also increased in current smokers who smoked longer than 10 years. Ex-smokers who smoked more than 10 years also showed increased risk for developing acute pancreatitis.

Risk for Acute Pancreatitis Based on Changes in Smoking Habits

Researchers categorized 2,617,306 individuals into 4 groups based on a different self-reported questionnaire that assessed changes in smoking habits during the health examination: 1,851,550 as never-smokers, 88,873 as new smokers, 127,751 as smokers who quit, and 549,132 as continuous smokers.

Continuous smokers were younger than those in the other 3 subgroups. People in any of the 3 smoker categories were more likely to be men and heavier drinkers. Those who quit smoking more likely developed diabetes, gallstones, and chronic pancreatitis, while hypertension and dyslipidemia were highest among never-smokers.

Compared to never-smokers, risk for developing acute pancreatitis increased among the 3 smoking subgroups with new (HR, 1.39; 95% CI, 1.19-1.62) and ex-smokers (HR, 1.4; 95% CI, 1.22-1.59) demonstrating slightly less risk than continuous smokers (HR, 1.62; 95% CI, 1.52-1.74). These trends persisted even after adjusting for potentially confounding baseline variables.

“Our results demonstrated a positive association between smoking and acute pancreatitis in a dose-response manner in the Korean population,” the study authors wrote. “Smoking cessation should be recommended to lower the incidence of acute pancreatitis.”

Study limitations include potential recall and response biases on self-reported questionnaires, lack of generalizability of results outside of the Asian (South Korean) population, inability to accurately classify gallstone-related acute pancreatitis vs nongallstone-related acute pancreatitis, and the relatively short-term follow-up period, which prevented analysis of long-term effects of smoking cessation.


Lee JM, Han KD, Lee SH, et al. The association between smoking, changes in smoking behavior, and acute pancreatitis: A population-based cohort study in Korea. J Gastroenterol Hepatol. Published online November 11, 2022. doi:10.1111/jgh.16061