S2883 Cigarette Smoking May Increase the Risk for Cirrhosis, Especially Among Women: Evidence From NHANES 2021-2023

Introduction: Cigarette smoking significantly contributes to the global disease burden. While its impact on cardiovascular and pulmonary disease is well-established, the relationship with liver disease remains under-investigated. This study aims to evaluate the association between cigarette smoking and liver-related outcomes in the United States using a large, nationally representative dataset. Methods: Cross-sectional study using the National Health and Nutrition Examination Survey 2021–2023 database. We included adults ≥18 years with valid liver stiffness measurements (LSMs) on vibration-controlled transient elastography (VCTE). Hepatic steatosis was defined by controlled attenuation parameter (CAP) ≥275 dB/m, advanced fibrosis by LSM 9.5–16.6 kPa, and cirrhosis by LSM >16.6 kPa. Survey-weighted logistic and linear regression analyses adjusted for demographic and clinical covariates evaluated associations between smoking status and liver outcomes. Subgroup analyses assessed interactions by gender, age, diabetes, and high-risk alcohol consumption (single session with ≥4 drinks for women or ≥5 drinks for men, or drinking alcohol at least twice/week). Results: The analysis included around 247 million weighted US adults, 56 million of whom were current smokers. Smokers were predominantly man, non-Hispanic White, and exhibited higher BMI, waist circumference, diabetes prevalence, and high-risk alcohol consumption (P < 0.01). Compared to non-smokers, smokers showed significantly elevated CAP scores (271.4 vs 252.2 dB/m, P < 0.001) and increased LSM (6.60 vs 5.79 kPa, P = 0.001). In adjusted model, smoking was associated with increased risk of advanced fibrosis, though not statistically significant (OR 1.18, 95% CI: 0.80–1.72, P = 0.36). Smoking was associated with significantly higher odds of cirrhosis (odds ratio [OR] 1.61, 95% CI: 1.05–2.49, P = 0.033). The association was notably stronger in women (OR 3.29, 95% CI: 2.18–4.97, P < 0.001) and individuals aged 40–60 years (OR 1.91, 95% CI: 1.08–3.38, P = 0.027). Conclusion: This population-based study demonstrates significant associations between smoking and increased risks of hepatic steatosis and cirrhosis, particularly among women and middle-aged adults. These findings emphasize the need for targeted smoking cessation interventions and further mechanistic research to elucidate tobacco's role in liver disease progression.