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The relationship between smoking and risk for colonic diverticular disease were investigated in a population-based cohort of women.A total of 35 809 women, born 1914-1948 in the Swedish Mammography Cohort were followed from 1997-2008. Information on smoking, diet and other lifestyle factors wereprospectively collected through a questionnaire. Cases of symptomatic diverticular disease were identified from the Swedish Patient Register. Relative risks (RR) were estimated as rate ratios using Coxproportional hazards models.Five hundred and fifty-nine cases of symptomatic diverticular disease were found. In multivariate analysis, current smokers had a 22% increased risk (RR = 1.22, 95% CI, 0.98-1.52) of symptomatic diverticular disease compared to non smokers after adjustment for age, intake of fiber, diabetes, hypertension, steroid medication, BMI, physical activity and educational level. Past smokers had a 26% increased risk (RR = 1.26, 1.03-1.56). A subgroup of 88 subjects was hospitalized due to diverticular perforation or abscess. Current smokers had a nearly doubled risk of developing diverticular perforation or abscess compared to those who never smoked (RR = 1.89, 1.22-3.23).Smoking is associated with symptomatic diverticular disease. The nearly doubled risk of perforation or abscess among smokers is important to be aware of when handling patients with acute symptoms of diverticulitis.