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Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study.
Piasecki, Thomas M; Smith, Stevens S; Baker, Timothy B; Slutske, Wendy S; Adsit, Robert T; Bolt, Daniel M; Conner, Karen L; Bernstein, Steven L; Eng, Oliver D; Lazuk, David; Gonzalez, Alec; Jorenby, Douglas E; D'Angelo, Heather; Kirsch, Julie A; Williams, Brian S; Nolan, Margaret B; Hayes-Birchler, Todd; Kent, Sean; Kim, Hanna; Lubanski, Stan; Yu, Menggang; Suk, Youmi; Cai, Yuxin; Kashyap, Nitu; Mathew, Jomol P; McMahan, Gabriel; Rolland, Betsy; Tindle, Hilary A; Warren, Graham W; An, Lawrence C; Boyd, Andrew D; Brunzell, Darlene H; Carrillo, Victor; Chen, Li-Shiun; Davis, James M; Deshmukh, Vikrant G; Dilip, Deepika; Ellerbeck, Edward F; Goldstein, Adam O; Iturrate, Eduardo; Jose, Thulasee; Khanna, Niharika; King, Andrea; Klass, Elizabeth; Mermelstein, Robin J; Tong, Elisa; Tsoh, Janice Y; Wilson, Karen M; Theobald, Wendy E; Fiore, Michael C.
  • Piasecki TM; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Smith SS; Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Baker TB; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Slutske WS; Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Adsit RT; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Bolt DM; Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Conner KL; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Bernstein SL; Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Eng OD; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Lazuk D; Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI, USA.
  • Gonzalez A; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Jorenby DE; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • D'Angelo H; Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
  • Kirsch JA; Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Williams BS; Yale-New Haven Health System, New Haven, CT, USA.
  • Nolan MB; BlueTree Network, a Tegria Company, Madison, WI, USA.
  • Hayes-Birchler T; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Kent S; Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Kim H; Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.
  • Lubanski S; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Yu M; Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Suk Y; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Cai Y; Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Kashyap N; Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Mathew JP; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • McMahan G; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Rolland B; Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA.
  • Tindle HA; Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI, USA.
  • Warren GW; United States Census Bureau, Washington, DC, USA.
  • An LC; Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.
  • Boyd AD; Department of Human Development, Teachers College Columbia University, New York, NY, USA.
  • Brunzell DH; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Carrillo V; Yale-New Haven Health System, New Haven, CT, USA.
  • Chen LS; Yale School of Medicine, New Haven, CT, USA.
  • Davis JM; Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Deshmukh VG; Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA.
  • Dilip D; Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
  • Ellerbeck EF; Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.
  • Goldstein AO; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
  • Iturrate E; Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA.
  • Jose T; Division of General Medicine, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
  • Khanna N; Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
  • King A; Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
  • Klass E; Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, USA.
  • Mermelstein RJ; Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
  • Tong E; Duke Cancer Institute and Duke University Department of Medicine, Durham, NC, USA.
  • Tsoh JY; University of Utah Health, Salt Lake City, UT, USA.
  • Wilson KM; Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Theobald WE; Department of Population Health, University of Kansas Medical Center, Kansas City, MO, USA.
  • Fiore MC; Department of Family Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Nicotine Tob Res ; 2022 Sep 07.
Article in English | MEDLINE | ID: covidwho-2325555
ABSTRACT

INTRODUCTION:

Available evidence is mixed concerning associations between smoking status and COVID-19 clinical outcomes. Effects of nicotine replacement therapy (NRT) and vaccination status on COVID-19 outcomes in smokers are unknown.

METHODS:

Electronic health record data from 104 590 COVID-19 patients hospitalized February 1, 2020 to September 30, 2021 in 21 U.S. health systems were analyzed to assess associations of smoking status, in-hospital NRT prescription, and vaccination status with in-hospital death and ICU admission.

RESULTS:

Current (n = 7764) and never smokers (n = 57 454) did not differ on outcomes after adjustment for age, sex, race, ethnicity, insurance, body mass index, and comorbidities. Former (vs never) smokers (n = 33 101) had higher adjusted odds of death (aOR, 1.11; 95% CI, 1.06-1.17) and ICU admission (aOR, 1.07; 95% CI, 1.04-1.11). Among current smokers, NRT prescription was associated with reduced mortality (aOR, 0.64; 95% CI, 0.50-0.82). Vaccination effects were significantly moderated by smoking status; vaccination was more strongly associated with reduced mortality among current (aOR, 0.29; 95% CI, 0.16-0.66) and former smokers (aOR, 0.47; 95% CI, 0.39-0.57) than for never smokers (aOR, 0.67; 95% CI, 0.57, 0.79). Vaccination was associated with reduced ICU admission more strongly among former (aOR, 0.74; 95% CI, 0.66-0.83) than never smokers (aOR, 0.87; 95% CI, 0.79-0.97).

CONCLUSIONS:

Former but not current smokers hospitalized with COVID-19 are at higher risk for severe outcomes. SARS-CoV-2 vaccination is associated with better hospital outcomes in COVID-19 patients, especially current and former smokers. NRT during COVID-19 hospitalization may reduce mortality for current smokers. IMPLICATIONS Prior findings regarding associations between smoking and severe COVID-19 disease outcomes have been inconsistent. This large cohort study suggests potential beneficial effects of nicotine replacement therapy on COVID-19 outcomes in current smokers and outsized benefits of SARS-CoV-2 vaccination in current and former smokers. Such findings may influence clinical practice and prevention efforts and motivate additional research that explores mechanisms for these effects.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Topics: Vaccines Language: English Journal subject: Public Health Year: 2022 Document Type: Article Affiliation country: Ntr

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Topics: Vaccines Language: English Journal subject: Public Health Year: 2022 Document Type: Article Affiliation country: Ntr