COVID‑19 and Current Smoking: Worse Outcome from a Surveillance Analysis
Abstract
Background: Few studies have shown that smokers are more likely than non‑smokers to have coronavirus disease 2019 (COVID‑19), whereas some reports indicate that smokers are under‑represented among those requiring hospital treatment for this illness. This study was designed and implemented for investigating the severity and outcome of COVID‑19 based on smoking.
Materials and Methods: This was a cross‑sectional study implemented in Tehran and Ahvaz with all COVID‑19 hospitalization patients from February to June 2021. Four categories selected for severity and worst outcomes. They are admission in the intensive care unit (ICU), lung involvement more than 50%, using more than three medications, and death. A check list of demographic data and smoking history was completed and analyzed.
Results: A total of 11,112 patients were male (61.1%), and the mean age was 47.9 ± 11.3. A total of 1508 smokers (8.3%) were seen with any type of tobacco consumption. The frequency of ICU admission in the smokers is significantly higher than that in non‑smokers (23.9% vs. 18.8%). A total of 668 (44.3%) smokers had more than 50% ground glass opacity in lungs, whereas 5340 non‑smokers (32.1%) had so. Use of more than three medications in the smokers was significantly higher (70.6% vs. 52%). A comparison between patients based on smoking indicates that the death rate was significantly higher in smokers (31.6% vs. 25.6%).
Conclusions: Although smoking rates in COVID‑19 patients are lower than those in the general population, the consequences and mortality are higher in smokers.
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Wu JT, Leung K, Leung GM. Nowcasting and forecasting the
potential domestic and international spread of the 2019-nCoV
outbreak originating in Wuhan, China: A modelling study. Lancet
;395:689-97.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early
transmission dynamics in Wuhan, China, of novel coronavirus–
infected pneumonia. N Engl J Med 2020;382:1199-1207.
Available from: https://www.worldometers.info/coronavirus/
country/iran/. [Last accessed on 2021 Sep 06].
Guan WJ, Ni ZY, Hu Y, Liang W-H, Ou C-Q, He J-X, et al.
Clinical characteristics of coronavirus disease 2019 in China.
N Engl J Med 2020;382:1708-20.
Lawrence H, Hunter A, Murray R, Lim WS, McKeever T.
Cigarette smoking and the occurrence of influenza–systematic
review. J Infect 2019;79:401-6.
World Health Organization. World Heart Federation,
Cardiovascular harms from tobacco use and secondhand smoke:
Global gaps in awareness and implications for action, Waterloo,
Ontario, Geneva; 2012.
World Health Organization. World No Tobacco Day 2018:
Tobacco breaks hearts-choose health. not tobacco, Geneva; 2018.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA,
Jemal A. Global cancer statistics 2018: GLOBOCAN estimates
of incidence and mortality worldwide for 36 cancers in 185
countries. CA Cancer J Clin 2018;68:394-424.
Lönnroth K, Raviglione M. Global epidemiology of
tuberculosis: Prospects for control. Semi Respir Crit Care Med
;29:481-91.
Terzikhan N, Verhamme KMC, Hofman A, Stricker BH,
Brusselle GG, Lahousse L. Prevalence and incidence of COPD
in smokers and non-smokers: The Rotterdam study. Eur J
Epidemiol 2016;31:785-92.
Institute for Health Metrics and Evaluation. GBD
Compare | IHME Viz Hub. Available from: http://vizhub.
healthdata.org/gbd-compare. [Last accessed 2020 Mar 12].
Janson C, Marks G, Buist S, Gnatiuc L, Gislason T,
McBurnie MA, et al. The impact of COPD on health status:
Findings from the BOLD study. Eur Respir J 2013;42:1472-83.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical
features of patients infected with 2019 novel coronavirus in
Wuhan, China. Lancet 2020;395:497-506.
Zheng Y-Y, Ma Y-T, Zhang J.-Y., Xie X. COVID-19 and the
cardiovascular system. Nat Rev Cardiol 2020;17:259-60.
Alhogbani T. Acute myocarditis associated with novel Middle
East respiratory syndrome coronavirus. Ann Saudi Med
;36:78-80.
Wu Q, Zhou L, Sun X, Yan Z, Hu C, Wu J, et al. Altered lipid
metabolism in recovered SARS patients twelve years after
infection. Sci Rep 2017;7:9110.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical
characteristics of 138 hospitalized patients with 2019 novel
coronavirus–infected pneumonia in Wuhan, China. JAMA
;323:1061-9.
Available from: https://www.webmd.com/lung/news/20200430/
smokers-hospitalized-less-often-for-covid-19.
Lee JJ, Wang MP, Yang SC. Will the tobacco industry ultimately
triumph in the midst of COVID-19 pandemic?: A call for nurses’
action in tobacco control. Int J Nurs Stud 2020;115:103726.
Available from: https://www.worldometers.info/coronavirus/
country/iran/. [Last accessed on 2021 Feb 17].
Ramezankhani A, Zaboli F, Zarghi A, Heydari GR. Smoking
habits of adolescent students in Tehran. Tanaffos 2010;9:33-42.
Fallah Tafti S, Jamaati HR, Heydarnejad H, Heydari GR,
Sharifi Milani H, Amini S, et al. Daily expenditure on cigarette
smoking in Tehran. Tanaffos 2006;5:65-70.
Moosazadeh M, Ziaaddini H, Mirzazadeh A,
Ashrafi-Asgarabad A, Haghdoost AA. Meta-analysis of smoking
prevalence in Iran. Addict Health 2013;5:140-53.
Berlin I, Thomas D, Le Faou A-L, Cornuz J. COVID-19 and
smoking. Nicotine Tob Res 2020;22:1-3.
Changeux J, Amoura Z, Rey F, Miyara M. A nicotinic hypothesis
for Covid-19 with preventive and therapeutic implications. C R
Biol 2020;343:33-9.
Available from: https://www.who.int/fctc/secretariat/head/
statements/2020/tobacco-control-during-covid-19-pandemic/en/.
Heydari G, Jianfar G, Alvanpour A, Hesami Z, Talischi F,
Masjedi MR. Efficacy of telephone quit line for smokers:
months follow up results. Tannafos 2011;10:42-8.
Heydari G, Arfaeinia H. COVID19 and smoking: More
severity and death – An experience from Iran. Lung India
;2021;38:S27-30.
Khorrami Z, Nili S, Sharifi H, Eybpoosh S, Shokoohi M.
Association of cigarette smoking, obesity, and underlying
medical conditions with COVID-19 hospitalization and mortality
in Iran: A nationwide retrospective ecological study. Med J Islam
Repub Iran 2020;34:133.