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Smoking and risk of COVID-19 hospitalization - 11/05/21

Doi : 10.1016/j.rmed.2021.106414 
Daniel Puebla Neira a, , Abigail Watts a, Justin Seashore a, Efstathia Polychronopoulou b, Yong-Fang Kuo b, c, Gulshan Sharma a
a Division of Pulmonary and Critical Care Medicine. Department of Internal Medicine, University of Texas Medical Branch. Galveston, TX, USA 
b Office of Biostatistics, University of Texas Medical Branch. Galveston, TX, USA 
c Sealy Center on Aging, University of Texas Medical Branch. Galveston, TX, USA 

Corresponding author. 301 University Blvd. Galveston, TX, 77555-0561, USA.301 University Blvd. GalvestonTX77555-0561USA

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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.

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Highlights

Former smokers are at higher risk for hospitalization and death from COVID-19 than current or never smokers.
Increase risk of hospitalizations seen among former smokers is mediated through older age and higher comorbidities burden.
Odds of hospitalization from COVID-19 increased by 6% for every year of age in the population studied after adjusting for other covariates.

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Keywords : COVID-19, SARS-COV2, Smoking, Hospitalization

Abbreviations List : Acute Respiratory Distress Syndrome, Angiotensin-Converting Enzyme 2, Body Mass Index, Centers for Disease Control and Prevention, Chronic Obstructive Pulmonary Disease, Chronic Kidney Disease, Congestive Heart Failure, Confidence Interval, Coronary Artery Disease, Coronavirus Disease 2019, Electronic Health Records, Emergency Department, End-Stage Renal Disease, Inpatient, International Classifications of Diseases version 10, Nicotine Replacement Therapy, Odds Ratio, Outpatient, Renin-Angiotensin System, Standard Deviation, Severe Acute Respiratory Syndrome Coronavirus 2


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Vol 182

Article 106414- juin 2021 Retour au numéro
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