Smoking and risk of COVID-19 hospitalization

Daniel Puebla Neira, Abigail Watts, Justin Seashore, Efstathia Polychronopoulou, Yong-Fang Kuo, Gulshan Sharma, Daniel Puebla Neira, Abigail Watts, Justin Seashore, Efstathia Polychronopoulou, Yong-Fang Kuo, Gulshan Sharma

Abstract

Rationale: The association between smoking status and severe Coronavirus Disease 2019 (COVID-19) remains controversial.

Objective: To assess the risk of hospitalization (as a marker of severe COVID-19) in patients by smoking status: former, current and never smokers, who tested positive for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2) at an academic medical center in the United States.

Methods: We conducted a retrospective cohort study in patients with SARS-COV2 between March-1-2020 and January-31-2021 to identify the risk of hospitalization due to COVID-19 by smoking status.

Results: We identified 10216 SARS-COV2-positive patients with complete documentation of smoking habits. Within 14 days of a SARS-COV2 positive test, 1150 (11.2%) patients were admitted and 188 (1.8%) died. Significantly more former smokers were hospitalized from COVID-19 than current or never smokers (21.2% former smokers; 7.3% current smokers; 10.4% never smokers, p<0.0001). In univariable analysis, former smokers had higher odds of hospitalization from COVID-19 than never smokers (OR 2.31; 95% CI 1.94-2.74). This association remained significant when analysis was adjusted for age, race and gender (OR 1.28; 95% CI 1.06-1.55), but became non-significant when analysis included Body Mass Index, previous hospitalization and number of comorbidities (OR 1.05; 95% CI 0.86-1.29). In contrast, current smokers were less likely than never smokers to be hospitalized due to COVID-19.

Conclusions: Significantly more former smokers were hospitalized and died from COVID-19 than current or never smokers. This effect is mediated via age and comorbidities in former smokers.

Keywords: COVID-19; Hospitalization; SARS-COV2; Smoking.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow Diagram of our cohort selection process. Smoking status was obtained within 2 years before SARS-COV2 positive test result. For patients with multiple records, we took the latest. A never smoker was defined as a patient who: 1) self-reported as never having been a smoker or 2) had

Fig. 2

Forrest plot of the multivariable…

Fig. 2

Forrest plot of the multivariable analysis evaluating the effect of smoking status on…

Fig. 2
Forrest plot of the multivariable analysis evaluating the effect of smoking status on the risk of 14-day hospitalization from COVID-19 unadjusted and adjusted for age, gender, race, BMI, number of comorbidities and inpatient hospital admission within the previous year. Definition of abbreviations: OR= Odds Ratio; CI: Confidence Interval; BMI: Body Mass Index; COVID-19: Coronavirus Disease 2019.
Fig. 2
Fig. 2
Forrest plot of the multivariable analysis evaluating the effect of smoking status on the risk of 14-day hospitalization from COVID-19 unadjusted and adjusted for age, gender, race, BMI, number of comorbidities and inpatient hospital admission within the previous year. Definition of abbreviations: OR= Odds Ratio; CI: Confidence Interval; BMI: Body Mass Index; COVID-19: Coronavirus Disease 2019.

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