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Dose–response relationship between cigarette smoking and risk of ulcerative colitis: a nationwide population-based study

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Former cigarette smokers are at risk of developing ulcerative colitis (UC). However, the impact of smoking behavior on the occurrence of UC according to the amount smoked remains elusive. We aimed to determine the relationship between smoking behavior and the risk of UC development.


We conducted a retrospective population-based cohort study using the National Health Insurance Service database in South Korea. From January 2009 to December 2012, 23,235,771 individuals over 18 years of age who underwent a national health examination were enrolled and followed until 2016. All study participants were divided into the following 3 groups: nonsmokers, former smokers, and current smokers. The primary endpoint was newly developed UC.


Compared with nonsmokers, the risk of UC development was significantly higher in former smokers [adjusted hazard ratio (aHR) 1.83; 95% confidence interval (CI) 1.73–1.95] but significantly lower in current smokers (aHR 0.92; 95% CI 0.87–0.98). Among current smokers, individuals who stopped smoking after the baseline evaluation had a significantly higher risk of UC development than those who continued to smoke (aHR 2.42; 95% CI 2.10–2.80). The risk of UC development among former smokers was significantly associated with smoking amount and duration. Among current smokers, however, the risk of UC development was not correlated with the cumulative lifetime smoking exposure. The preventive effect of current smoking on UC development was observed only in men (aHR 0.90; 95% CI 0.84–0.96).


Compared with nonsmokers, former smokers have a significantly higher risk of UC development that may be proportional to the cumulative smoking exposure.

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Fig. 1
Fig. 2



Adjusted hazard ratio


Body mass index


Confidence interval


Diabetes mellitus


Hazard ratio


International Classification of Disease, Tenth Revision


National Health Insurance Service


Nurses' Health Study I


Nurses' Health Study II


Rare intractable disease


Ulcerative colitis


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Authors and Affiliations



SP, JC, and KDH: research conception and design; SP, KDH, HS, and EAK: data acquisition; SP, JC, and KDH: data analysis and interpretation; KDH: statistical analysis; SP and JC: manuscript drafting; HJL, JPI, and JSK: critical revision of the manuscript; all authors: approval of the final manuscript.

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Correspondence to Jaeyoung Chun.

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Supplementary Fig. 1 Cumulative incidence of ulcerative colitis according to (a) smoking status at baseline and (b) changes in smoking status among current smokers at baseline. UC, ulcerative colitis (DOCX 14 kb)

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Park, S., Chun, J., Han, KD. et al. Dose–response relationship between cigarette smoking and risk of ulcerative colitis: a nationwide population-based study. J Gastroenterol 54, 881–890 (2019).

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