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Effect modification by age of the association between obstructive lung diseases, smoking, and COVID-19 severity.
Moschovis, Peter P; Lu, Mengdi; Hayden, Douglas; Yonker, Lael M; Lombay, Jesiel; Taveras, Elsie; Arauz Boudreau, Alexy; Triant, Virginia A; Foulkes, Andrea S; Bassett, Ingrid; Hibberd, Patricia L; Kinane, T Bernard.
  • Moschovis PP; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA pmoschovis@mgh.harvard.edu.
  • Lu M; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Hayden D; Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Yonker LM; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Lombay J; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Taveras E; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Arauz Boudreau A; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Triant VA; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Foulkes AS; Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Bassett I; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Hibberd PL; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
  • Kinane TB; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
BMJ Open Respir Res ; 8(1)2021 11.
Article in English | MEDLINE | ID: covidwho-1504421
ABSTRACT

INTRODUCTION:

Obstructive lung diseases (asthma and chronic obstructive pulmonary disease (COPD)) and smoking are associated with greater risk of respiratory infections and hospitalisations, but conflicting data exist regarding their association with severity of COVID-19, and few studies have evaluated whether these associations differ by age.

OBJECTIVES:

To examine the associations between asthma, COPD and smoking on the severity of COVID-19 among a cohort of hospitalised patients, and to test for effect modification by age.

METHODS:

We performed a retrospective analysis of electronic health record data of patients admitted to Massachusetts General Hospital, assigning the maximal WHO Clinical Progression Scale score for each patient during the first 28 days following hospital admission. Using ordered logistic regression, we measured the association between maximal severity score and asthma, COPD and smoking and their interaction with age. MEASUREMENTS AND MAIN

RESULTS:

Among 1391 patients hospitalised with COVID-19, we found an increased risk of severe disease among patients with COPD and prior smoking, independent of age. We also found evidence of effect modification by age with asthma and current smoking; in particular, asthma was associated with decreased COVID-19 severity among older adults, and current smoking was associated with decreased severity among younger patients.

CONCLUSIONS:

This cohort study identifies age as a modifying factor for the association between asthma and smoking on severity of COVID-19. Our findings highlight the complexities of determining risk factors for COVID-19 severity, and suggest that the effect of risk factors may vary across the age spectrum.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Disease, Chronic Obstructive / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Humans Language: English Year: 2021 Document Type: Article Affiliation country: Bmjresp-2021-001038

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Disease, Chronic Obstructive / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Humans Language: English Year: 2021 Document Type: Article Affiliation country: Bmjresp-2021-001038