M1372 Smoking is Under Appreciated as a Risk Factor for Chronic Pancreatitis

Abstract

Background: Despite data showing an independent association between smoking and chronic pancreatitis (CP), it is unclear how often physicians consider smoking as a CP risk factor. Aim: Identify how often and in which patients physicians identify smoking as a CP risk factor. Methods: We analyzed data on CP patients (n = 535) prospectively enrolled in the multicenter North American Pancreatitis Study 2 (NAPS2). Patient self-reported smoking status was stratified as never, past, or current, and the amount and duration of smoking was quantified. For each patient, we noted whether the enrolling physician classified alcohol as the diagnostic etiology for CP and whether or not smoking was selected as a risk factor. Results: Among 382 (71.4%) self-reported past or current smokers, physicians cited smoking as a risk factor in only 173 (45.3%) patients, more often when they considered alcohol as CP etiology (54.5 vs. 32.5%, p<0.001). Among patients considered to have alcohol as an etiology, physicians identified smoking as a risk factor equally irrespective of the status (current vs. past) (55.4 vs. 51.1%, p= NS) or the amount of smoking. Among patients not classified as having an alcohol etiology, physicians were more likely to cite smoking as a risk factor in current rather than past smokers (47.4% vs. 19.0%, p<0.001) and in patients who reported higher amount and duration of smoking. Although patient's self-reported smoking status was generally similar across participating centers, a wide variability in physician decision to cite smoking as a risk factor was observed (Figure 1). On multivariable regression analyses however, the association between smoking and CP was independent of physician's decision to cite smoking as a risk factor. Conclusions: Cigarette smoking is common in CP patients. Physicians often underestimate smoking as a CP risk factor. Efforts are needed to increase awareness of the association between smoking and CP.