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Journal of Digestive Diseases 2014; 15; 501–507

doi: 10.1111/1751-2980.12168

Original article

Risk factors of acute pancreatitis in the elderly Chinese population: A population-based cross-sectional study Hong YANG,1* Li WANG,1† Yi Hai SHI,* Guang Tao SUI,‡ Yun Fei WU,‡ Xin Qing LU,* Mei Yu LI,§ Qing XIA,§ Xiao Xia BIAN,‡ Hai Hua LI§ & Jia Ming QIAN* *Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, †Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, School of Basic Medicine, Beijing, ‡Department of Research, Daqing Petroleum Administration Bureau Daqing General Hospital, and §Department of Gastroenterology, Daqing Longnan Hospital, Daqing, Heilongjiang Province, China

OBJECTIVE: Lifestyle changes have led to an increasing incidence of acute pancreatitis (AP) in China. The aims of this study were to evaluate the association between lifestyle as well as medical history and AP in the elderly population and to provide evidence towards the prevention against AP. METHODS: A population-based cross-sectional study was conducted in Daqing, Heilongjiang Province, China. A total of 23 294 residents aged ≥55 years were enrolled in the study. A questionnaire survey was conducted to collect data on participants’ characteristics, lifestyle and medical history via a face-to-face interview, and compared these data with the medical chart. RESULTS: In total, 45 participants had been diagnosed with AP, that is, a prevalence of 0.19%. No significant differences were observed with respect to KEY WORDS:

their age, gender, marital status or body mass index (BMI) in participants with and without AP. However, those were better educated were more likely to develop AP (P = 0.005). The univariate analysis showed that a high meat intake, smoking, alcohol consumption and a medical history of gallstones were associated with a significant increase in the risk of developing AP (P < 0.05). Furthermore, smoking or alcohol consumption was dose-dependently associated with the risk of AP, particularly in those who smoked at least 15 pack-years or consumed ≥56.2 drinks per year. Multivariable logistics analysis suggested that the level of education, smoking and medical history of gallstone are independent risk factors for AP. CONCLUSIONS: Our study indicated that a higher education level, smoking, alcohol consumption and history of gallstones may be potential risk factors for AP in the elderly in northeast China.

acute pancreatitis, alcohol consumption, diabetes, gallstone, risk factor, smoking.

INTRODUCTION Correspondence to: Jia Ming QIAN, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. Email: [email protected] 1

These authors contributed equally to this work.

Conflict of interest: None.

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas. The severity of AP varies from © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd

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a mild, self-limiting disease to a rapidly progressive illness accompanied with local and/or systematic complications.1,2 Approximately 20% of the patients with AP will progress to a life-threatening condition including multiorgan failure. The incidence of AP has been increasing over the past four decades in many countries.3,4 A better understanding of its risk factors could decrease the incidence of AP, among which the two most common risk factors are cholelithiasis and alcohol abuse. Several other risk factors have also been mentioned, including obesity and hypertriglyceridemia, as well as some medications.3,5 Number of cases with cholelityiasis-related AP has been increasingly reported, which is paralleled with an increase in the prevalence of obesity.6 Cholelityiasis-related AP is more commonly seen in women, whereas alcoholassociated pancreatitis is predominant in middle-aged men.6 The incidence and mortality of AP increases with the patients’ age.2 However, the roles of some factors such as long-term diet, smoking and diabetes mellitus play in the pathogenesis of the disease remains controversial or even unclear. Furthermore, the etiologies of AP may vary among different countries or even among different areas within the same country.7 Although the incidence of AP in China is increasing, population-based data are inadequate. Northeast China is an area known to have a high prevalence of alcohol consumption. Our previous study8 showed that mortality from pancreatic cancer in this area was higher than that in other areas in Mainland China. There have been no reports on the prevalence of AP and related risk factors in this area. The Daqing Petroleum Administration Bureau (DQPAB) is an oil production company located in the Heilongjiang Province which is located at the Northeast China. With a population of 554 800 organized in 29 communities, DQPAB is not just an ordinary company; it also serves as a government administration in managing the well-being and welfare of its employees and their families. In order to investigate the prevalence and risk factors of AP in Northeast China, a population-based cross-sectional study was conducted in the elderly population in the DQPAB. PATIENTS AND METHODS Study design and participants This study was approved by the Institutional Review Board of the Peking Union Medical College Hospital (Beijing, China) and the DQPAB (Daqing,

Journal of Digestive Diseases 2014; 15; 501–507 Heilongjiang Province, China). Written informed consent was obtained from all the participants. From 1 June 2006 to 31 May 2007, residents aged ≥55 years from two communities in the DQPAB were included in this study. A questionnaire on their clinical characteristics, lifestyle and medical history was administered by the community health staffs who had been trained by digestive specialists. The patients’ height and weight were self-reported to allow the researchers to calculate their body mass index (BMI). Their medical history, including the presence of AP, type 2 diabetes (T2DM) and cholelithiasis, was determined from responses to the following questions: 1. Have you ever been diagnosed with AP? 2. Have you ever been diagnosed with gallstones? 3. Have you even been diagnosed with T2DM? If the answer was ‘yes’ to any of the abovementioned questions, the participant was then inquired about the time at which the disease was diagnosed. The participants who were diagnosed with cholelithiasis or T2DM prior to the diagnosis of AP were considered to have a positive medical history. Additionally, in order to guarantee the validity of these answers, the selfreported AP history was compared with that recorded in the individual’s medical chart. The diagnosis of AP was confirmed based on the Chinese guideline for the diagnosis and management of AP in 2004,9 when at least two of the following criteria were fulfilled: (i) acute abdominal pain and tenderness in the upper abdomen; (ii) elevated blood pancreatic enzymes levels; (iii) envidence of ultrasonography, computed tomography or magnetic resonance imaging findings suggesting AP. The agreement between the self-reports and the medical charts was 93.3%. Definitions The participants were defined as smokers if they had smoked for up to one year before the date of the review. Information was collected on the number of cigarettes smoked per day and the age at which the participants started smoking. The number of packyears (calculated as: [cigarettes smoking per day/ 20] × length of smoking [years]) was determined as the cumulative cigarette dose level. For participants who smoked a pipe, 50 g of pipe was converted to 10 cigarettes. Light or heavy smokers were categorized using the 50th percentile pack-years value of the control subjects as the cut-off point (i.e.

Risk factors of acute pancreatitis in the elderly Chinese population: a population-based cross-sectional study.

Lifestyle changes have led to an increasing incidence of acute pancreatitis (AP) in China. The aims of this study were to evaluate the association bet...
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