Gu Dian, Ha Patrick, Kaye Jesse T, Fiore Michael C, Tsoh Janice Y
The Center for Tobacco Control Research and Education, University of California, San Francisco, CA, United States.
Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, CA, United States.
Addict Behav Rep. 2024 Sep 26;20:100565. doi: 10.1016/j.abrep.2024.100565. eCollection 2024 Dec.
Research investigating the association between cigarette smoking and COVID-19 outcomes has yielded mixed results, often overlooking cannabis use. This study examined the association between cigarette smoking and COVID-19 hospitalization with consideration of cannabis use.
We used electronic health record data from adult patients with COVID-19 (2/1/2020 to 2/3/2022) at a northern California academic medical center. The outcome was COVID-19 hospitalization. We conducted three multivariable logistic models to examine the relationship between cigarette smoking and hospitalization. Model 1 included cigarette smoking status and other covariates; Model 2 added cannabis use status to Model 1; Model 3 added interaction term of cigarette and cannabis use to Model 2, followed by a post-hoc analysis.
Of the 14,440 patients, 8.5 % had COVID-19 hospitalization, 4.9 % and 24.1 % currently and formerly smoked cigarettes, respectively; 7.2 % currently used cannabis, 62.8 % had unknown cannabis use status. Both current and former cigarettes smoking were associated with hospitalization (Models 1-2). In Model 3, the cigarette-cannabis interaction was significant. Former cigarette smoking had higher odds for hospitalization (adjusted odds ratio [AOR] = 1.36; 95 % confidence interval [CI] 1.09-1.70) only among people who did not currently use cannabis. Current cigarette smoking yielded higher odds of hospitalization (AOR = 1.47; 95 % CI 1.02-2.12) among people whose cannabis use was unknown. Cigarette smoking status was not associated with hospitalization among people who currently used cannabis.
Cigarette smoking's associations with COVID-19 hospitalization varied by cannabis use. Future research should include both cigarette and cannabis use in understanding risk factors for COVID-19 outcomes.
关于吸烟与新冠病毒病（COVID-19）结局之间关联的研究结果不一，且常常忽略大麻使用情况。本研究在考虑大麻使用的情况下，考察了吸烟与COVID-19住院治疗之间的关联。
我们使用了加利福尼亚州北部一家学术医疗中心成年COVID-19患者（2020年1月2日至2022年2月3日）的电子健康记录数据。结局指标为COVID-19住院治疗情况。我们进行了三个多变量逻辑回归模型，以考察吸烟与住院治疗之间的关系。模型1纳入了吸烟状况及其他协变量；模型2在模型1的基础上增加了大麻使用状况；模型3在模型2的基础上增加了吸烟与大麻使用的交互项，随后进行事后分析。
在14440名患者中，8.5%的患者因COVID-19住院治疗，目前吸烟者和既往吸烟者分别占4.9%和24.1%；7.2%的患者目前使用大麻，62.8%的患者大麻使用状况未知。目前吸烟和既往吸烟均与住院治疗有关（模型1至模型2）。在模型3中，吸烟与大麻的交互作用显著。仅在目前不使用大麻的人群中，既往吸烟导致住院的几率更高（调整优势比[AOR]=1.36；95%置信区间[CI]1.09 - 1.70）。在大麻使用状况未知的人群中，目前吸烟导致住院的几率更高（AOR = 1.47；95%CI 1.02 - 2.12）。在目前使用大麻的人群中，吸烟状况与住院治疗无关。
吸烟与COVID-19住院治疗之间的关联因大麻使用情况而异。未来的研究在理解COVID-19结局的风险因素时应同时纳入吸烟和大麻使用情况。
