Smoking status, nicotine medication, vaccination, and COVID-19 hospital outcomes: Findings from the COVID EHR cohort at the University of Wisconsin (CEC-UW) study Journal Article

Authors: Piasecki, T. M.; Smith, S. S.; Baker, T. B.; Slutske, W. S.; Adsit, R. T.; Bolt, D. M.; Conner, K. L.; Bernstein, S. L.; Eng, O. D.; Lazuk, D.; Gonzalez, A.; Jorenby, D. E.; D'Angelo, H.; Kirsch, J. A.; Williams, B. S.; Nolan, M. B.; Hayes-Birchler, T.; Kent, S.; Kim, H.; Lubanski, S.; Yu, M.; Suk, Y.; Cai, Y.; Kashyap, N.; Mathew, J. P.; McMahan, G.; Rolland, B.; Tindle, H. A.; Warren, G. W.; An, L. C.; Boyd, A. D.; Brunzell, D. H.; Carrillo, V.; Chen, L. S.; Davis, J. M.; Deshmukh, V. G.; Dilip, D.; Ellerbeck, E. F.; Goldstein, A. O.; Iturrate, E.; Jose, T.; Khanna, N.; King, A.; Klass, E.; Mermelstein, R. J.; Tong, E.; Tsoh, J. Y.; Wilson, K. M.; Theobald, W. E.; Fiore, M. C.
Article Title: Smoking status, nicotine medication, vaccination, and COVID-19 hospital outcomes: Findings from the COVID EHR cohort at the University of Wisconsin (CEC-UW) study
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. © The Author(s) 2022. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.
Keywords: cohort studies; cohort analysis; smoking cessation; smoking; hospital; hospitals; nicotine; university; hospital mortality; universities; nicotine gum; humans; human; wisconsin; severe acute respiratory syndrome coronavirus 2; coronavirus disease 2019; covid-19; sars-cov-2; tobacco use cessation devices; covid-19 vaccines; sars-cov-2 vaccine
Journal Title: Nicotine & Tobacco Research
Volume: 25
Issue: 6
ISSN: 1462-2203
Publisher: Oxford University Press  
Date Published: 2023-06-01
Start Page: 1184
End Page: 1193
Language: English
DOI: 10.1093/ntr/ntac201
PUBMED: 36069915
PROVIDER: scopus
PMCID: PMC9494410
Notes: Article -- Export Date: 1 June 2023 -- Source: Scopus
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MSK Authors
  1. Deepika Dilip
    11 Dilip