Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study.
dc.contributor.author | Piasecki, Thomas M | |
dc.contributor.author | Smith, Stevens S | |
dc.contributor.author | Baker, Timothy B | |
dc.contributor.author | Slutske, Wendy S | |
dc.contributor.author | Adsit, Robert T | |
dc.contributor.author | Bolt, Daniel M | |
dc.contributor.author | Conner, Karen L | |
dc.contributor.author | Bernstein, Steven L | |
dc.contributor.author | Eng, Oliver D | |
dc.contributor.author | Lazuk, David | |
dc.contributor.author | Gonzalez, Alec | |
dc.contributor.author | Jorenby, Douglas E | |
dc.contributor.author | D'Angelo, Heather | |
dc.contributor.author | Kirsch, Julie A | |
dc.contributor.author | Williams, Brian S | |
dc.contributor.author | Nolan, Margaret B | |
dc.contributor.author | Hayes-Birchler, Todd | |
dc.contributor.author | Kent, Sean | |
dc.contributor.author | Kim, Hanna | |
dc.contributor.author | Lubanski, Stan | |
dc.contributor.author | Yu, Menggang | |
dc.contributor.author | Suk, Youmi | |
dc.contributor.author | Cai, Yuxin | |
dc.contributor.author | Kashyap, Nitu | |
dc.contributor.author | Mathew, Jomol P | |
dc.contributor.author | McMahan, Gabriel | |
dc.contributor.author | Rolland, Betsy | |
dc.contributor.author | Tindle, Hilary A | |
dc.contributor.author | Warren, Graham W | |
dc.contributor.author | An, Lawrence C | |
dc.contributor.author | Boyd, Andrew D | |
dc.contributor.author | Brunzell, Darlene H | |
dc.contributor.author | Carrillo, Victor | |
dc.contributor.author | Chen, Li-Shiun | |
dc.contributor.author | Davis, James M | |
dc.contributor.author | Deshmukh, Vikrant G | |
dc.contributor.author | Dilip, Deepika | |
dc.contributor.author | Ellerbeck, Edward F | |
dc.contributor.author | Goldstein, Adam O | |
dc.contributor.author | Iturrate, Eduardo | |
dc.contributor.author | Jose, Thulasee | |
dc.contributor.author | Khanna, Niharika | |
dc.contributor.author | King, Andrea | |
dc.contributor.author | Klass, Elizabeth | |
dc.contributor.author | Mermelstein, Robin J | |
dc.contributor.author | Tong, Elisa | |
dc.contributor.author | Tsoh, Janice Y | |
dc.contributor.author | Wilson, Karen M | |
dc.contributor.author | Theobald, Wendy E | |
dc.contributor.author | Fiore, Michael C | |
dc.date.accessioned | 2022-11-01T13:43:16Z | |
dc.date.available | 2022-11-01T13:43:16Z | |
dc.date.issued | 2022-09 | |
dc.date.updated | 2022-11-01T13:43:14Z | |
dc.description.abstract | IntroductionAvailable 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.MethodsElectronic 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.ResultsCurrent (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).ConclusionsFormer 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.ImplicationsPrior 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. | |
dc.identifier | 6693781 | |
dc.identifier.issn | 1462-2203 | |
dc.identifier.issn | 1469-994X | |
dc.identifier.uri | ||
dc.language | eng | |
dc.publisher | Oxford University Press (OUP) | |
dc.relation.ispartof | Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco | |
dc.relation.isversionof | 10.1093/ntr/ntac201 | |
dc.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. | |
dc.type | Journal article | |
duke.contributor.orcid | Davis, James M|0000-0002-7196-5649 | |
pubs.begin-page | ntac201 | |
pubs.organisational-group | Duke | |
pubs.organisational-group | School of Medicine | |
pubs.organisational-group | Clinical Science Departments | |
pubs.organisational-group | Institutes and Centers | |
pubs.organisational-group | Medicine | |
pubs.organisational-group | Medicine, General Internal Medicine | |
pubs.organisational-group | Duke Cancer Institute | |
pubs.publication-status | Published |
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