Abstract
INTRODUCTIONCOVID-19 has major effects on the clinical, humanistic and economic outcomes among patients, producing severe symptoms and death. Smoking has been reported as one of the factors that increases severity and mortality rate among COVID-19 patients. However, the effect of smoking on such medical outcomes is still controversial. This study conducted a comprehensive systematic review and meta-analysis (SR/MA) on the association between smoking and negative outcomes among COVID-19 patients.METHODSElectronic databases, including PubMed, EMBASE, Cochrane Library, Science Direct, Google Scholar, were systematically searched from the initiation of the database until 12 December 2020. All relevant studies about smoking and COVID-19 were screened using a set of inclusion and exclusion criteria. The Newcastle–Ottawa Scale was used to assess the methodological quality of eligible articles. Random meta-analyses were conducted to estimate odds ratios (ORs) with 95% confidence interval (CIs). Publication bias was assessed using the funnel plot, Begg’s test and Egger’s test.RESULTSA total of 1248 studies were retrieved and reviewed. A total of 40 studies were finally included for meta-analysis. Both current smoking and former smoking significantly increase the risk of disease severity (OR=1.58; 95% CI: 1.16–2.15, p=0.004; and OR=2.48; 95% CI: 1.64–3.77, p<0.001; respectively) with moderate appearance of heterogeneity. Similarly, current smoking and former smoking also significantly increase the risk of death (OR=1.35; 95% CI: 1.12–1.62, p=0.002; and OR=2.58; 95% CI: 2.15–3.09, p<0.001; respectively) with moderate appearance of heterogeneity. There was no evidence of publication bias, which was tested by the funnel plot, Begg’s test and Egger’s test.CONCLUSIONSSmoking, even current smoking or former smoking, significantly increases the risk of COVID-19 severity and death. Further causational studies on this association and ascertianing the underlying mechanisms of this relation is warranted.
Highlights
INTRODUCTION COVID19 has major effects on the clinical, humanistic and economic outcomes among patients, producing severe symptoms and death
Since December 2019, there has been an outbreak of pneumonia of unknown etiology that was first reported in Wuhan, Hubei Province, China
Synthesis of results The results in younger patients (≤65 years) showed that both current smoking and former smoking significantly increase the risk of disease severity (OR=1.58; 95% confidence interval (CI): 1.16–2.15, p=0.004; and odds ratio (OR)=2.48; 95% CI: 1.64–3.77, p
Summary
19 has major effects on the clinical, humanistic and economic outcomes among patients, producing severe symptoms and death. Smoking has been reported as one of the factors that increases severity and mortality rate among COVID-19 patients. A novel coronavirus SARS-CoV-2 disease, COVID-19, was identified by the World Health Organization (WHO) as the causative virus for the pandemic in China and other parts of the world with more than 30 million cases of infection and 0.9 million deaths globally[1]. COVID-19 pandemic caused poor mental health and quality of life, as reported. This pandemic is seen to be far from over and there is a continuing resurgence in many countries. COVID-19 has had a significant global economic impact and a huge burden on healthcare resources[4]
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