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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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    "description": "<p><strong>Introduction: </strong>Smoking impairs lung immune functions and damages upper airways, increasing risks of contracting and severity of infectious diseases.</p>\n\n<p><strong>Methods: </strong>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.</p>\n\n<p><strong>Results: </strong>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.</p>\n\n<p><strong>Conclusions: </strong>Smoking is an independent risk for having severe progression of COVID-19, including mortality. The effects seem to be higher among young people.</p>\n\n<p><strong>Implications:</strong> Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic.</p>", 
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    "title": "Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: a systematic review and meta-analysis", 
    "notes": "<p>Funding provided by: National Institute on Drug Abuse<br>Crossref Funder Registry ID: http://dx.doi.org/10.13039/100000026<br>Award Number: R01DA043950</p><p>Funding provided by: National Institutes of Health<br>Crossref Funder Registry ID: http://dx.doi.org/10.13039/100000002<br>Award Number: U54HL147127</p>", 
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    "publication_date": "2020-09-30", 
    "creators": [
      {
        "orcid": "0000-0002-8357-8961", 
        "affiliation": "University of California San Francisco Medical Center", 
        "name": "Glantz, Stanton"
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        "affiliation": "University of California San Francisco Medical Center", 
        "name": "Patanavanich, Roengrudee"
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    "method": "<p>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.</p>", 
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