Srikanth Maddika, MD1, Eric O. Then, MD1, Febin John, MD2, Khalil Aloreidi, MD2, Vijay Gayam, MD3, Vijay S. Are, MD4, Andrea Culliford, MD, FACG1, Vinaya Gaduputi, MD, FACG5
1St. Barnabas Hospital, Bronx, NY; 2The Brooklyn Hospital Center, Brooklyn, NY; 3Interfaith Medical Center, Brooklyn, NY; 4Stormont Vail Health System, Topeka, KS; 5SBH Health System, Bronx, NY
Introduction: Diverticulitis is inflammation of a previously existing diverticulum. Complicated diverticulitis is characterized by the formation of phlegmon, abscess, obstruction or perforation. Recent meta-analysis proved a positive association between tobacco and diverticulosis, but there is a lack of robust data on the effect of tobacco smoking on diverticulitis.
Methods: We retrospectively analyzed patients hospitalized with diverticulitis (via ICD-9 codes) in 2016 using the Nationwide Inpatient Sample (NIS) Database. Our primary end point was to establish a relationship between patients diagnosed with diverticulitis and tobacco smokers. We also analyzed the relationship between smoking and the presence of complicated versus non-complicated diverticulitis. Finally we analyzed the relationship between the presence of diverticulitis with race and gender. Univariate and multivariate logistic regression models were developed using STATA software version 15.
Results: A total of 331,999 patients with diverticulitis were included in our study population. We found that patients with diverticulitis were 35% more likely to be tobacco smokers than non-smokers (OR: 1.359; CI: 1.329-1.389; P-value: 0.000). This relationship was stronger in patients with complicated diverticulitis where 49% were more likely to be tobacco smokers than non-smokers (OR: 1.495; CI: 1.451- 1.540; P-value: 0.000). In addition patients with complicated diverticulitis presented at a younger age in tobacco smokers than in non-smokers (mean age: 59.23 vs 61.55; P-value: 0.0001). On multivariate analysis adjusting for possible confounding factors we found that smoking (OR: 1.30; CI: 1.27-1.33; P-value: 0.00), Caucasian race (OR: 1.731; CI: 1.596- 1.878; P-value: 0.000), female gender (OR: 1.09; CI: 1.07-1.11; P-value: 0.00), and colon cancer (OR: 1.07; CI: 1.01-1.15; P-value: 0.02) were all associated with an increased likelihood of diverticulitis. In contrast, diverticulitis was 14% less likely to occur in black patients (OR: 0.865; CI: 0.793-0.944; P-value: 0.001).
Discussion: We conclude there is a positive association between tobacco smoking and diverticulitis. Smoking increases the risk of complicated diverticulitis and this tends to occur at a younger age compared to non-smokers. Incidence of diverticulitis is more common in whites and least common among blacks when compared to other races. Given these findings more robust measures should be implemented to help young adults quit smoking tobacco.
Citation: Srikanth Maddika, MD; Eric O. Then, MD; Febin John, MD; Khalil Aloreidi, MD; Vijay Gayam, MD; Vijay S. Are, MD; Andrea Culliford, MD, FACG; Vinaya Gaduputi, MD, FACG. P0118 - IS SMOKING ASSOCIATED WITH AN INCREASED RISK OF DIVERTICULITIS?. Program No. P0118. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.