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Smoking Status and Factors associated with COVID-19 In-Hospital Mortality among US Veterans
Javad Razjouyan1,2,3,4, Drew A Helmer1,2, Kristine E Lynch5
1VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
Summary
Former smokers face higher COVID-19 in-hospital mortality risk than never smokers. Current smokers showed similar risk, indicating a need for further research into smoking
Area of Science:
- Public Health
- Epidemiology
- Internal Medicine
Background:
- The impact of smoking on COVID-19 mortality remains uncertain.
- Understanding risk factors for in-hospital mortality in COVID-19 patients is crucial.
Purpose of the Study:
- To investigate the association between smoking status and in-hospital mortality among COVID-19 patients.
- To identify other factors influencing COVID-19 in-hospital mortality within the U.S. Veterans Health Administration (VHA).
Main Methods:
- Retrospective cohort study utilizing VHA COVID-19 shared data resources (February 1 to September 11, 2020).
- Categorization of hospitalized SARS-CoV-2 positive veterans into Never (NS), Former (FS), and Current Smokers (CS).
- Logistic regression models with machine learning-determined covariates and imputed smoking status to assess in-hospital mortality.
Main Results:
- Former smokers (FS) exhibited a significantly higher adjusted odds ratio (aOR) for in-hospital mortality (1.16; 95%CI 1.01, 1.32) compared to never smokers (NS).
- Current smokers (CS) did not show a statistically significant difference in mortality risk compared to never smokers (aOR 0.97; 95%CI 0.78, 1.22).
- Factors associated with increased mortality included diabetes with complications, kidney disease, obesity, and advanced age; famotidine and NSAID use were associated with lower risk.
Conclusions:
- Former smoking status is linked to an elevated risk of in-hospital mortality in COVID-19 patients.
- The risk pattern for current smokers was not distinct from never smokers, underscoring the need for detailed analysis of smoking data.
- Comorbidities and advanced age remain significant predictors of adverse outcomes in hospitalized COVID-19 patients.
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