Severs M, Mangen M-J J, van der Valk M E, Fidder H H, Dijkstra G, van der Have M, van Bodegraven A A, de Jong D J, van der Woude C J, Romberg-Camps M J L, Clemens C H M, Jansen J M, van de Meeberg P C, Mahmmod N, Ponsioen C Y, Vermeijden J R, van der Meulen-de Jong A E, Pierik M, Siersema P D, Oldenburg B
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Crohns Colitis. 2017 Mar 1;11(3):342-352. doi: 10.1093/ecco-jcc/jjw160.
Smoking affects the course of inflammatory bowel disease [IBD]. We aimed to study the impact of smoking on IBD-specific costs and health-related quality-of-life [HrQoL] among adults with Crohn's disease [CD] and ulcerative colitis [UC].
A large cohort of IBD patients was prospectively followed during 1 year using 3-monthly questionnaires on smoking status, health resources, disease activity and HrQoL. Costs were calculated by multiplying used resources with corresponding unit prices. Healthcare costs, patient costs, productivity losses, disease course items and HrQoL were compared between smokers, never-smokers and ex-smokers, adjusted for potential confounders.
In total, 3030 patients [1558 CD, 1054 UC, 418 IBD-unknown] were enrolled; 16% smoked at baseline. In CD, disease course was more severe among smokers. Smoking was associated with > 30% higher annual societal costs in IBD (€7,905 [95% confidence interval €6,234 - €9,864] vs €6,017 [€5,186 - €6,946] in never-smokers and €5,710 [€4,687 - €6,878] in ex-smokers, p = 0.06 and p = 0.04, respectively). In CD, smoking patients generated the highest societal costs, primarily driven by the use of anti-tumour necrosis factor compounds. In UC, societal costs of smoking patients were comparable to those of non-smokers. Societal costs of IBD patients who quitted smoking > 5 years before inclusion were lower than in patients who quitted within the past 5 years (€ 5,135 [95% CI €4,122 - €6,303] vs €9,342 [€6,010 - €12,788], p = 0.01). In both CD and UC, smoking was associated with a lower HrQoL.
Smoking is associated with higher societal costs and lower HrQoL in IBD patients. Smoking cessation may result in considerably lower societal costs.
吸烟会影响炎症性肠病（IBD）的病程。我们旨在研究吸烟对克罗恩病（CD）和溃疡性结肠炎（UC）成年患者IBD相关费用及健康相关生活质量（HrQoL）的影响。
对一大群IBD患者进行为期1年的前瞻性随访，每3个月使用问卷询问吸烟状况、医疗资源、疾病活动及HrQoL。费用通过将使用的资源乘以相应单价来计算。对吸烟者、从不吸烟者和已戒烟者的医疗费用、患者费用、生产力损失、疾病病程项目及HrQoL进行比较，并对潜在混杂因素进行校正。
共纳入3030例患者（1558例CD、1054例UC、418例IBD类型不明）；16%的患者在基线时吸烟。在CD患者中，吸烟者的疾病病程更严重。吸烟使IBD患者的年度社会成本增加30%以上（吸烟者为7905欧元[95%置信区间6234欧元 - 9864欧元]，从不吸烟者为6017欧元[5186欧元 - 6946欧元]，已戒烟者为5710欧元[4687欧元 - 6878欧元]，p值分别为0.06和0.04）。在CD患者中，吸烟患者产生的社会成本最高，主要是由于使用抗肿瘤坏死因子化合物。在UC患者中，吸烟患者的社会成本与非吸烟者相当。纳入研究前戒烟超过5年的IBD患者的社会成本低于在过去5年内戒烟的患者（5135欧元[95%置信区间4122欧元 - 6303欧元] vs 9342欧元[6010欧元 - 12788欧元]，p = 0.01）。在CD和UC患者中，吸烟均与较低的HrQoL相关。
吸烟与IBD患者较高的社会成本及较低的HrQoL相关。戒烟可能会使社会成本大幅降低。
