Patanavanich Roengrudee, Siripoon Tanatorn, Amponnavarat Salin, Glantz Stanton A
Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Center for Tobacco Control Research and Education (retired), University of California San Francisco, San Francisco, CA, USA.
Nicotine Tob Res. 2023 Jan 5;25(2):177-184. doi: 10.1093/ntr/ntac085.
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.
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.
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).
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.
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.
目前的证据表明，吸烟会使新冠疫情的后果恶化。然而，当研究将分析局限于当前吸烟者时，新冠疫情严重程度和死亡风险并不一致。
本荟萃分析基于报告了所有三类吸烟情况（当前吸烟者、既往吸烟者和从不吸烟者）的研究，探讨当前吸烟与死亡风险之间的关联，以克服先前荟萃分析中可能将既往吸烟者归类为非吸烟者的局限性。我们检索了截至2021年1月1日的PubMed和Embase数据库。我们纳入了报告新冠患者所有三类吸烟行为及死亡结局的研究。采用随机效应荟萃分析和荟萃回归来检验数据中的关系。
共纳入34篇文章，涉及35193名新冠患者。荟萃分析证实了当前吸烟（优势比[OR]1.26，95%置信区间[CI]：1.01 - 1.58）和既往吸烟（OR 1.76，95% CI：1.53 - 2.03）与新冠死亡之间的关联。我们还发现，当前吸烟者的新冠死亡风险不因年龄而异，但既往吸烟者的该风险随年龄显著下降。此外，与高收入国家相比，非高收入国家的当前吸烟者有更高的新冠死亡风险（OR 3.11，95% CI：2.04 - 4.72对比OR 1.14，95% CI：0.91 - 1.43；p = 0.015）。
当前吸烟者和既往吸烟者死于新冠的风险更高。应加强烟草控制，鼓励当前吸烟者戒烟并防止开始吸烟。公共卫生专业人员应将新冠疫情作为促进吸烟预防和戒烟的契机。
本研究通过区分当前吸烟和既往吸烟及其对新冠死亡的不同影响，为现有文献做出了重要贡献。我们还探讨了患者年龄和国家收入水平的影响。本研究结果为反对吸烟与新冠死亡关系的错误信息提供了实证依据。
