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The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: a living rapid evidence review with Bayesian meta-analyses (version 7).
Addiction. 2021 06; 116(6):1319-1368.A

Abstract

AIMS

To estimate the association of smoking status with rates of (i) infection, (ii) hospitalization, (iii) disease severity and (iv) mortality from SARS-CoV-2/COVID-19 disease.

DESIGN

Living rapid review of observational and experimental studies with random-effects hierarchical Bayesian meta-analyses. Published articles and pre-prints were identified via MEDLINE and medRxiv.

SETTING

Community or hospital, no restrictions on location.

PARTICIPANTS

Adults who received a SARS-CoV-2 test or a COVID-19 diagnosis.

MEASUREMENTS

Outcomes were SARS-CoV-2 infection, hospitalization, disease severity and mortality stratified by smoking status. Study quality was assessed (i.e. 'good', 'fair' and 'poor').

FINDINGS

Version 7 (searches up to 25 August 2020) included 233 studies with 32 'good' and 'fair' quality studies included in meta-analyses. Fifty-seven studies (24.5%) reported current, former and never smoking status. Recorded smoking prevalence among people with COVID-19 was generally lower than national prevalence. Current compared with never smokers were at reduced risk of SARS-CoV-2 infection [relative risk (RR) = 0.74, 95% credible interval (CrI) = 0.58-0.93, τ = 0.41]. Data for former smokers were inconclusive (RR = 1.05, 95% CrI = 0.95-1.17, τ = 0.17), but favoured there being no important association (21% probability of RR ≥ 1.1). Former compared with never smokers were at somewhat increased risk of hospitalization (RR = 1.20, CrI = 1.03-1.44, τ = 0.17), greater disease severity (RR = 1.52, CrI = 1.13-2.07, τ = 0.29) and mortality (RR = 1.39, 95% CrI = 1.09-1.87, τ = 0.27). Data for current smokers were inconclusive (RR = 1.06, CrI = 0.82-1.35, τ = 0.27; RR = 1.25, CrI = 0.85-1.93, τ = 0.34; RR = 1.22, 95% CrI = 0.78-1.94, τ = 0.49, respectively), but favoured there being no important associations with hospitalization and mortality (35% and 70% probability of RR ≥ 1.1, respectively) and a small but important association with disease severity (79% probability of RR ≥ 1.1).

CONCLUSIONS

Compared with never smokers, current smokers appear to be at reduced risk of SARS-CoV-2 infection, while former smokers appear to be at increased risk of hospitalization, increased disease severity and mortality from COVID-19. However, it is uncertain whether these associations are causal.

Authors+Show Affiliations

Centre for Emerging, Endemic and Exotic Diseases, Royal Veterinary College, London, UK.Department of Behavioural Science and Health, University College London, London, UK.Department of Behavioural Science and Health, University College London, London, UK.Department of Behavioural Science and Health, University College London, London, UK.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

33007104

Citation

Simons, David, et al. "The Association of Smoking Status With SARS-CoV-2 Infection, Hospitalization and Mortality From COVID-19: a Living Rapid Evidence Review With Bayesian Meta-analyses (version 7)." Addiction (Abingdon, England), vol. 116, no. 6, 2021, pp. 1319-1368.
Simons D, Shahab L, Brown J, et al. The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: a living rapid evidence review with Bayesian meta-analyses (version 7). Addiction. 2021;116(6):1319-1368.
Simons, D., Shahab, L., Brown, J., & Perski, O. (2021). The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: a living rapid evidence review with Bayesian meta-analyses (version 7). Addiction (Abingdon, England), 116(6), 1319-1368. https://doi.org/10.1111/add.15276
Simons D, et al. The Association of Smoking Status With SARS-CoV-2 Infection, Hospitalization and Mortality From COVID-19: a Living Rapid Evidence Review With Bayesian Meta-analyses (version 7). Addiction. 2021;116(6):1319-1368. PubMed PMID: 33007104.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: a living rapid evidence review with Bayesian meta-analyses (version 7). AU - Simons,David, AU - Shahab,Lion, AU - Brown,Jamie, AU - Perski,Olga, Y1 - 2020/11/17/ PY - 2020/07/08/revised PY - 2020/04/24/received PY - 2020/09/25/accepted PY - 2020/10/3/pubmed PY - 2021/6/8/medline PY - 2020/10/2/entrez KW - COVID-19 KW - SARS-CoV-2 KW - e-cigarettes KW - hospitalization KW - infection KW - living review KW - mortality KW - nicotine replacement therapy KW - smoking KW - tobacco SP - 1319 EP - 1368 JF - Addiction (Abingdon, England) JO - Addiction VL - 116 IS - 6 N2 - AIMS: To estimate the association of smoking status with rates of (i) infection, (ii) hospitalization, (iii) disease severity and (iv) mortality from SARS-CoV-2/COVID-19 disease. DESIGN: Living rapid review of observational and experimental studies with random-effects hierarchical Bayesian meta-analyses. Published articles and pre-prints were identified via MEDLINE and medRxiv. SETTING: Community or hospital, no restrictions on location. PARTICIPANTS: Adults who received a SARS-CoV-2 test or a COVID-19 diagnosis. MEASUREMENTS: Outcomes were SARS-CoV-2 infection, hospitalization, disease severity and mortality stratified by smoking status. Study quality was assessed (i.e. 'good', 'fair' and 'poor'). FINDINGS: Version 7 (searches up to 25 August 2020) included 233 studies with 32 'good' and 'fair' quality studies included in meta-analyses. Fifty-seven studies (24.5%) reported current, former and never smoking status. Recorded smoking prevalence among people with COVID-19 was generally lower than national prevalence. Current compared with never smokers were at reduced risk of SARS-CoV-2 infection [relative risk (RR) = 0.74, 95% credible interval (CrI) = 0.58-0.93, τ = 0.41]. Data for former smokers were inconclusive (RR = 1.05, 95% CrI = 0.95-1.17, τ = 0.17), but favoured there being no important association (21% probability of RR ≥ 1.1). Former compared with never smokers were at somewhat increased risk of hospitalization (RR = 1.20, CrI = 1.03-1.44, τ = 0.17), greater disease severity (RR = 1.52, CrI = 1.13-2.07, τ = 0.29) and mortality (RR = 1.39, 95% CrI = 1.09-1.87, τ = 0.27). Data for current smokers were inconclusive (RR = 1.06, CrI = 0.82-1.35, τ = 0.27; RR = 1.25, CrI = 0.85-1.93, τ = 0.34; RR = 1.22, 95% CrI = 0.78-1.94, τ = 0.49, respectively), but favoured there being no important associations with hospitalization and mortality (35% and 70% probability of RR ≥ 1.1, respectively) and a small but important association with disease severity (79% probability of RR ≥ 1.1). CONCLUSIONS: Compared with never smokers, current smokers appear to be at reduced risk of SARS-CoV-2 infection, while former smokers appear to be at increased risk of hospitalization, increased disease severity and mortality from COVID-19. However, it is uncertain whether these associations are causal. SN - 1360-0443 UR - https://www.unboundmedicine.com/medline/citation/33007104/The_association_of_smoking_status_with_SARS_CoV_2_infection_hospitalization_and_mortality_from_COVID_19:_a_living_rapid_evidence_review_with_Bayesian_meta_analyses__version_7__ L2 - https://doi.org/10.1111/add.15276 DB - PRIME DP - Unbound Medicine ER -