Mostafa Aya, El-Sayed Manal H, El-Meteini Mahmoud, Saleh Ayman, Omar Ashraf, Mansour Ossama, Girgis Samia, Hafez Hala, Kandil Sahar
Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, 38 Ramses st., Abbassia square, PO-box 11566, Cairo, Egypt.
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
BMC Public Health. 2021 Jun 28;21(1):1243. doi: 10.1186/s12889-021-11290-x.
Smoking negatively impacts COVID-19 severity and adverse outcomes. Evidence on whether smoking is associated with SARS-Co-V2 infection and having a positive test is scarce, particularly from low-and middle-income countries, where most of the world's billion smokers live. The inconsistency in relevant findings calls for study designs and analyses to account for possible confounders including background characteristics and pre-existing co-morbidities, to disentangle the specific effect of smoking. In healthcare workers (HCWs) the frequency of exposure to COVID-19 cases adds another layer of risk that was not factored in previous studies. We examined the association of HCWs' tobacco/nicotine use (never, former, and current use) with having a positive SARS-Co-V2 test result and symptoms suggestive of infection, accounting for demographics, exposures, and co-morbidities.
A prospective cohort study of 4040 healthcare workers with baseline and follow-up screening took place during April-June 2020 in 12 healthcare facilities in Cairo, Egypt. Data on demographics, tobacco/nicotine use (manufactured or roll-your-own cigarettes, waterpipe tobacco, and electronic devices), co-morbidities, symptoms, exposures, and SARS-Co-V2 investigations were analyzed. Multinomial and multivariable logistic regression analyses were performed.
Overall, 270/4040 (6.7, 95%CI: 5.9-7.5) had positive SARS-CoV-2 tests, 479 (11.9%) were current and 79 (2.0%) were former tobacco/nicotine users. The proportion of positive tests was 7.0% (243/3482, 95%CI: 6.1-7.8) among never, 5.1% (4/79, 95%CI: 0.1-10.0) among former, and 4.8% (23/479, 95%CI: 2.9-6.7) among current users. HCWs' SARS-CoV-2 test results did not vary significantly by single/multiple or daily/non-daily tobacco/nicotine use. Compared to never users, former users were more likely to self-report a pre-existing medical condition (OR1.87, 95%CI: 1.05-3.33, p = 0.033), and to experience symptoms suggestive of COVID-19 (OR1.76, 95%CI: 1.07-2.90, p = 0.027). After adjustment, former (OR0.45, 95%CI: 0.11-1.89, p = 0.273) and current (OR0.65, 95%CI: 0.38-1.09, p = 0.101) tobacco/nicotine use was not associated with HCWs' SARS-CoV-2 positive test results.
This is the first report on this association from low- and middle-income countries with high tobacco/nicotine use prevalence. In this HCW cohort, having a positive SARS-CoV-2 test was not associated with tobacco/nicotine use after accounting for demographics, exposures, and co-morbidities. Additional population-based studies could use such preliminary evidence to investigate this controversial association.
吸烟会对新冠病毒疾病的严重程度和不良后果产生负面影响。关于吸烟是否与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染及检测呈阳性相关的证据很少，特别是在低收入和中等收入国家，而全球数十亿吸烟者大多生活在这些国家。相关研究结果的不一致性要求在研究设计和分析中考虑可能的混杂因素，包括背景特征和既往并存疾病，以厘清吸烟的具体影响。在医护人员中，接触新冠病毒病例的频率增加了另一层风险，而这在以往研究中并未考虑在内。我们研究了医护人员的烟草/尼古丁使用情况（从不使用、曾经使用和当前使用）与SARS-CoV-2检测呈阳性以及提示感染的症状之间的关联，并考虑了人口统计学、接触情况和并存疾病等因素。
2020年4月至6月期间，在埃及开罗的12家医疗机构对4040名医护人员进行了一项前瞻性队列研究，进行了基线和随访筛查。分析了有关人口统计学、烟草/尼古丁使用情况（机制卷烟或手卷烟、水烟、电子设备）、并存疾病、症状、接触情况和SARS-CoV-2检测的相关数据。进行了多项和多变量逻辑回归分析。
总体而言，4040人中270人（6.7%，95%置信区间：5.9%-7.5%）SARS-CoV-2检测呈阳性，479人（11.9%）为当前烟草/尼古丁使用者，79人（2.0%）为曾经的烟草/尼古丁使用者。从不使用者中检测呈阳性的比例为7.0%（243/3482，95%置信区间：6.1%-7.8%），曾经使用者中为5.1%（4/79，95%置信区间：0.1%-10.0%），当前使用者中为4.8%（23/479，95%置信区间：2.9%-6.7%）。医护人员的SARS-CoV-2检测结果在单一/多种或每日/非每日烟草/尼古丁使用方面无显著差异。与从不使用者相比，曾经使用者更有可能自我报告存在既往疾病（比值比1.87，95%置信区间：1.05-3.33，p=0.033），且更有可能出现提示感染新冠病毒的症状（比值比1.76，95%置信区间：1.07-2.90，p=0.027）。调整后，曾经（比值比0.45，95%置信区间：0.11-1.89，p=0.273）和当前（比值比0.65，95%置信区间：0.38-1.09，p=0.101）烟草/尼古丁使用与医护人员SARS-CoV-2检测呈阳性结果无关。
这是来自烟草/尼古丁使用率较高的低收入和中等收入国家关于这一关联的首份报告。在这个医护人员队列中，在考虑了人口统计学、接触情况和并存疾病等因素后，SARS-CoV-2检测呈阳性与烟草/尼古丁使用无关。更多基于人群的研究可以利用这些初步证据来调查这一有争议的关联。
