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Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: a systematic review and meta-analysis

Glantz, Stanton; Patanavanich, Roengrudee

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      <creatorName>Glantz, Stanton</creatorName>
      <nameIdentifier nameIdentifierScheme="ORCID" schemeURI="">0000-0002-8357-8961</nameIdentifier>
      <affiliation>University of California San Francisco Medical Center</affiliation>
      <creatorName>Patanavanich, Roengrudee</creatorName>
      <affiliation>University of California San Francisco Medical Center</affiliation>
    <title>Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: a systematic review and meta-analysis</title>
    <date dateType="Issued">2020-09-30</date>
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    <relatedIdentifier relatedIdentifierType="DOI" relationType="IsIdenticalTo">10.7272/Q6CF9NBQ</relatedIdentifier>
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    <rights rightsURI="">Creative Commons Zero v1.0 Universal</rights>
    <rights rightsURI="info:eu-repo/semantics/openAccess">Open Access</rights>
    <description descriptionType="Abstract">&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Smoking impairs lung immune functions and damages upper airways, increasing risks of contracting and severity of infectious diseases.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched PubMed for studies published from January 1-May 25, 2020. We included studies reporting smoking behavior of COVID-19 patients and progression of disease, including death. We used a random effects meta-analysis and used meta-regression and lowess regressions to examine relationships in the data.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 47 peer-reviewed papers with a total of 31,871 COVID-19 patients, 5,759 (18.1%) experienced disease progression and 5,734 (18.0%) with a history of smoking. Among smokers, 29.2% experienced disease progression, compared with 21.1% of non-smokers. The meta-analysis confirmed an association between smoking and COVID-19 progression (OR 1.56, 95% CI 1.32-1.83, p=0.001). Smoking was associated with increased risk of death from COVID-19 (OR 1.19, 95% CI 1.05-1.34, p=0.007). We found no significant difference (p=0.432) between the effects of smoking on COVID-19 disease progression between adjusted and unadjusted analyses, suggesting that smoking is an independent risk factor for COVID-19 disease progression. We also found the risk of having COVID-19 progression among younger adults (p=0.023), with the effect most pronounced among people under about 45 years old.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Smoking is an independent risk for having severe progression of COVID-19, including mortality. The effects seem to be higher among young people.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Implications:&lt;/strong&gt; Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic.&lt;/p&gt;</description>
    <description descriptionType="Other">&lt;p&gt;Funding provided by: National Institute on Drug Abuse&lt;br&gt;Crossref Funder Registry ID:;br&gt;Award Number: R01DA043950&lt;/p&gt;&lt;p&gt;Funding provided by: National Institutes of Health&lt;br&gt;Crossref Funder Registry ID:;br&gt;Award Number: U54HL147127&lt;/p&gt;</description>
    <description descriptionType="Methods">&lt;p&gt;We conducted a systematic search using PubMed on May 25, 2020, with the search term: "((smoking) OR (characteristics) OR (risk factors) OR (retrospective*) OR (outcomes) OR (smoker*)) AND ((COVID-19) OR (COVID) OR (coronavirus) OR (sars cov-2) OR (sars cov 2))" for studies published between January 1, 2020 and May 25, 2020. A total of 2,600 studies were retrieved through the search.&lt;/p&gt;</description>
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