Active Smokers Are at Higher Risk of COVID-19 Death: A Systematic Review and Meta-analysis
Issued Date
2023-01-05
Resource Type
eISSN
1469994X
Scopus ID
2-s2.0-85145955798
Pubmed ID
35363877
Journal Title
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Volume
25
Issue
2
Start Page
177
End Page
184
Rights Holder(s)
SCOPUS
Bibliographic Citation
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Vol.25 No.2 (2023) , 177-184
Suggested Citation
Patanavanich R., Siripoon T., Amponnavarat S., Glantz S.A. Active Smokers Are at Higher Risk of COVID-19 Death: A Systematic Review and Meta-analysis. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Vol.25 No.2 (2023) , 177-184. 184. doi:10.1093/ntr/ntac085 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82467
Title
Active Smokers Are at Higher Risk of COVID-19 Death: A Systematic Review and Meta-analysis
Author(s)
Other Contributor(s)
Abstract
INTRODUCTION: Current evidence indicates that smoking worsens COVID-19 outcomes. However, when studies restricted their analyses to current smokers, the risks for COVID-19 severity and death are inconsistent. AIMS AND METHODS: This meta-analysis explored the association between current smoking and the risk for mortality based on the studies that reported all three categories of smoking (current, former, and never smokers) to overcome the limitation of the previous meta-analyses which former smokers might have been classified as nonsmokers. We searched PubMed and Embase up to January 1, 2021. We included studies reporting all three categories of smoking behaviors of COVID-19 patients and mortality outcomes. A random-effects meta-analysis and meta-regression were used to examine relationships in the data. RESULTS: A total of 34 articles with 35 193 COVID-19 patients was included. The meta-analysis confirmed the association between current smoking (odds ratio [OR] 1.26, 95% confidence interval [CI]: 1.01-1.58) and former smoking (OR 1.76, 95% CI: 1.53-2.03) with COVID-19 mortality. We also found that the risk for COVID-19 death in current smokers does not vary by age, but significantly drops by age in former smokers. Moreover, current smokers in non-high-income countries have higher risks of COVID-19 death compared with high-income countries (OR 3.11, 95% CI: 2.04-4.72 vs. OR 1.14, 95% CI: 0.91-1.43; p = .015). CONCLUSIONS: Current and former smokers are at higher risk of dying from COVID-19. Tobacco control should be strengthened to encourage current smokers to quit and prevent the initiation of smoking. Public health professionals should take the COVID-19 pandemic as an opportunity to promote smoking prevention and cession. IMPLICATIONS: This study makes an important contribution to the existing literature by distinguishing between current and former smoking and their separate effects on COVID-19 mortality. We also explore the effects by age of patients and country income level. Findings from this study provide empirical evidence against misinformation about the relationship between smoking and COVID-19 mortality.