Assessment of Severe COVID-19 Outcomes Using Measures of Smoking Status and Smoking Intensity

Abstract

Objective: Smoking status does not indicate the amount or length of tobacco use, and thus, it is an imperfect measure to assess the association between cigarette smoking and severe coronavirus disease 2019 (COVID-19) outcomes. This investigation assessed whether cigarette smoking status, intensity of smoking (i.e., average daily packs of cigarettes smoked), duration of smoking, and pack-years of smoking are associated with severe outcomes among adults diagnosed with COVID-19. Methods: We conducted a retrospective, cross-sectional study in which we identified consecutive patients diagnosed with COVID-19 at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020 who had complete information on smoking status, severe COVID-19 outcomes, and covariates (i.e., demographics and comorbidities). We used logistic regression to evaluate the associations of smoking status and intensity of smoking with COVID-19 severity, defined as hospitalization, admission to intensive care unit (ICU), or death, adjusting for sociodemographics and comorbidities. Results: Among the 4611 COVID-19 patients included in the analysis, 18.2% were current smokers and 20.7% were former smokers. The prevalence of COVID-19 outcomes was 28.9% for hospitalization, 9.8% for ICU admission, and 1.4% for death. In the adjusted analysis, current smoking (AOR: 1.23, 95% CI: 1.02–1.49), former smoking (AOR: 1.28, 95% CI: 1.07–1.54), and pack-years of smoking (AOR: 1.09, 95% CI: 1.02–1.17) were associated with a higher prevalence of hospitalization. Average daily packs of cigarettes smoked was associated with a higher prevalence of hospitalization (AOR: 1.30, 95% CI: 1.10–1.53) and ICU admission (AOR: 1.23, 95% CI: 1.04–1.44). Conclusions: Smoking status, pack-years, and intensity of smoking were associated with hospitalizations in patients with COVID-19 and intensity of smoking was associated with ICU admission. The findings underscore the need for detailed information beyond smoking status when evaluating smokers with COVID-19 so that the potential for adverse sequelae may be optimally managed in at-risk patients.

Assessing Smoking Status and Risk of SARS-CoV-2 Infection: A Machine Learning Approach among Veterans

“…Patients with a history of cancer had a significantly reduced risk (aOR 0.72; 95% CI: 71, 0.73). Previous studies also reported a reduced risk of infection among cancer patients [7,11]. It is possible that cancer patients may be more likely to get tested when asymptomatic; thus, the reduced risk may be related to care seeking behaviors and screening for COVID-19.…”

“…Smoking is a huge healthcare concern because it is common and an established major risk factor for most preventable diseases, including certain types of cancers, cardiovascular diseases, diabetes, respiratory illnesses, and other infectious diseases [ 3 , 4 , 5 ]. Many of these conditions, such as respiratory illnesses [ 2 , 6 , 7 , 8 ], cardiovascular disease [ 2 , 7 ], cancer [ 7 ], chronic kidney disease [ 6 , 7 ], chronic diabetes [ 6 , 7 ], obesity [ 6 ], hypertension [ 7 ], and neurological diseases [ 2 ], are also important risk factors for worse clinical outcomes (hospitalization, ICU admission, and death) in patients with COVID-19.…”

Association Between Tobacco Use and COVID-19: A Narrative Review

“…Tobacco also doubles the death rate (3). Hospitalization rates for current smokers and former smokers are 1.2 and 1.3 times higher than those of never smokers, respectively (57).…”

“…Weakening lung function and the immune system, tobacco and cigarettes aggravate the complications of COVID-19 (57,61). Although the results of a study indicated that tobacco had a slight effect on the lungs of COVID-19 patients and there was no significant difference between the smokers and nonsmokers, smoking may not increase the severity of the disease through the lungs.…”

“…Shortly after the onset of the COVID-19 pandemic, the WHO announced a higher risk of outcome in smokers compared to non-smokers (57). A study in China in early March 2020 stated that smoking is the most important risk factor for a poor prognosis of COVID-19 (58).…”