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The association of smoking status with SARS-CoV-2 infection, hospitalisation and mortality from COVID-19: A living rapid evidence review with Bayesian meta-analyses (version 7).

Simons, D; Shahab, L; Brown, J; Perski, O

Authors

D Simons

L Shahab

J Brown

O Perski



Abstract

To estimate the association of smoking status with rates of i) infection, ii) hospitalisation, iii) disease severity, and iv) mortality from SARS-CoV-2/COVID-19 disease. 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. Community or hospital. No restrictions on location. Adults who received a SARS-CoV-2 test or a COVID-19 diagnosis. Outcomes were SARS-CoV-2 infection, hospitalisation, disease severity and mortality stratified by smoking status. Study quality was assessed (i.e. 'good', 'fair' and 'poor'). 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 (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 hospitalisation (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 hospitalisation 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). 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 hospitalisation, increased disease severity and mortality from COVID-19. However, it is uncertain whether these associations are causal. [Abstract copyright: This article is protected by copyright. All rights reserved.]

Citation

Simons, D., Shahab, L., Brown, J., & Perski, O. (2020). The association of smoking status with SARS-CoV-2 infection, hospitalisation and mortality from COVID-19: A living rapid evidence review with Bayesian meta-analyses (version 7). Addiction,

Journal Article Type Review
Acceptance Date Sep 23, 2020
Publication Date Oct 2, 2020
Deposit Date Oct 29, 2020
Publicly Available Date Oct 29, 2020
Journal Addiction (Abingdon, England)
Print ISSN 0965-2140
Electronic ISSN 1360-0443
Publisher Wiley
Peer Reviewed Peer Reviewed
Keywords COVID-19, SARS-CoV-2, e-cigarettes, hospitalisation, infection, living review, mortality, nicotine replacement therapy, smoking, tobacco
Public URL https://rvc-repository.worktribe.com/output/1375444

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