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Smoking as the most important risk factor for chronic pancreatitis in the general population


We tested the hypothesis that six toxic risk factors from the TIGAR-O classification system are equally important for risk of chronic pancreatitis, at the level of the individual patient and in the general population. 108,438 women and men aged 20–100 years participating in the Copenhagen General Population Study from 2003 to 2015 were included. Associations of smoking, alcohol intake, waist/hip ratio, kidney function, plasma triglycerides, plasma Ca2+, and diseases within the causal pathway with risk of chronic pancreatitis, and corresponding population attributable risks were estimated. Information on chronic pancreatitis was from national Danish health registries. During median 9 years (range: 0–15) of follow-up, 313 individuals had a first diagnosis of chronic pancreatitis; the incidence of chronic pancreatitis per 10,000 person-years were 3.1 overall, 2.8 in women, and 3.5 in men. Of the six toxic risk factors and relative to individuals with low values, individuals in the top 5% had hazard ratios for chronic pancreatitis of 3.1(95% CI 2.1–4.5) for pack-years smoked, 2.5(1.5–4.0) for alcohol intake, and 1.6(1.1–2.6) for plasma triglycerides. Corresponding values versus those without the baseline disease were 12.6 (7.9–20.2) for acute pancreatitis, 1.9 (1.2–2.8) for gallstone disease, and 1.9 (1.3–2.7) for diabetes mellitus. The highest population attributable fractions were for women (1) ever smoking (31%), (2) gallstone disease (5%), and (3) diabetes mellitus (4%), and for men (1) ever smoking (38%), (2) acute pancreatitis (7%)/high alcohol intake (7%), and (3) high plasma triglycerides (5%). Smoking is the most important risk factor for chronic pancreatitis in the general population.

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Availability of data and material

Data and further analyses will be made available upon reasonable request to corresponding author. The Danish Data Protection Agency does not allow open access to our data.

Code availability

Coding will be made available upon reasonable request to corresponding author.


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We would like to thank staff and participants from the Copenhagen General Population Study for their valuable contributions.


This work was funded by the Novo Nordisk Foundation, Denmark, the Independent Research Fund, Denmark, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark, and Chief Physician Johan Boserup and Lise Boserup’s Fund, Denmark. The Copenhagen General Population Study was supported by Herlev and Gentofte Hospital, Copenhagen University Hospital, the Danish Heart Foundation, the Danish Medical Research Council, and the Copenhagen County Foundation.

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SEJH, BGN, and AL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analyses. Study concept and design: SEJH, BGN, and AL. Acquisition, analyses and interpretation of data: SEJH, BGN, and AL. Drafting of manuscript: SEJH. Critical revision of the manuscript for important intellectual content: BGN and AL. Statistical analyses: SEJH and AL. Study supervision: BGN and AL.

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Correspondence to Anne Langsted.

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Hansen, S.E.J., Nordestgaard, B.G. & Langsted, A. Smoking as the most important risk factor for chronic pancreatitis in the general population. Eur J Epidemiol 38, 95–107 (2023).

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  • Epidemiology
  • Cohort study
  • Pancreas
  • Gastroenterology
  • Prevention
  • Smoking
  • Pancreatitis