Abstract
BackgroundMuch of what is known about COVID-19 risk factors comes from patients with serious symptoms who test positive. While risk factors for hospitalization or death include chronic conditions and smoking; less is known about how health status or nicotine consumption is associated with risk of SARS-CoV-2 infection among individuals who do not present clinically.MethodsTwo community-based population samples (including individuals randomly and nonrandomly selected for statewide testing, n = 8214) underwent SARS-CoV-2 testing in nonclinical settings. Each participant was tested for current (viral PCR) and past (antibody) infection in either April or June of 2020. Before testing, participants provided demographic information and self-reported health status and nicotine and tobacco behaviors (smoking, chewing, vaping/e-cigarettes). Using descriptive statistics and a bivariate logistic regression model, we examined the association between health status and use of tobacco or nicotine with SARS-CoV-2 positivity on either PCR or antibody tests.ResultsCompared to people with self-identified “excellent” or very good health status, those reporting “good” or “fair” health status had a higher risk of past or current infections. Positive smoking status was inversely associated with SARS-CoV-2 infection. Chewing tobacco was associated with infection and the use of vaping/e-cigarettes was not associated with infection.ConclusionsIn a statewide, community-based population drawn for SARS-CoV-2 testing, we find that overall health status was associated with infection rates. Unlike in studies of COVID-19 patients, smoking status was inversely associated with SARS-CoV-2 positivity. More research is needed to further understand the nature of this relationship.
Highlights
Much of what is known about COVID-19 risk factors comes from patients with serious symptoms who test positive
Early data from China identified smokers as overrepresented among severely ill COVID-19 patients and smoking appeared to be a significant risk factor for severe infection and adverse outcomes [1]
The use of vaping/e-cigarettes was not associated with infection rates (OR = 0.654, 95% CI: 0.32–1.35)
Summary
Much of what is known about COVID-19 risk factors comes from patients with serious symptoms who test positive. While risk factors for hospitalization or death include chronic conditions and smoking; less is known about how health status or nicotine consumption is associated with risk of SARS-CoV-2 infection among individuals who do not present clinically. Data from China identified smokers as overrepresented among severely ill COVID-19 patients and smoking appeared to be a significant risk factor for severe infection and adverse outcomes [1]. Comorbid conditions (which are more common among smokers), and increased age were first identified as risk factors for severe disease and death in China [2,3,4,5]. At the beginning of the pandemic, most of the existing epidemiological information was based on those with severe disease because asymptomatic and mildly symptomatic individuals are not routinely tested in the United States nor many other countries
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