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

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Smith, Stevens S

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Baker, Timothy B

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Slutske, Wendy S

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Adsit, Robert T

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Bolt, Daniel M

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Conner, Karen L

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Bernstein, Steven L

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Eng, Oliver D

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Lazuk, David

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Gonzalez, Alec

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Jorenby, Douglas E

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D'Angelo, Heather

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Kirsch, Julie A

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Williams, Brian S

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Nolan, Margaret B

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Hayes-Birchler, Todd

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Kent, Sean

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Kim, Hanna

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Lubanski, Stan

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Yu, Menggang

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Suk, Youmi

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Cai, Yuxin

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Kashyap, Nitu

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Mathew, Jomol P

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McMahan, Gabriel

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Rolland, Betsy

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Tindle, Hilary A

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Warren, Graham W

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An, Lawrence C

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Boyd, Andrew D

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Brunzell, Darlene H

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Carrillo, Victor

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Chen, Li-Shiun

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Davis, James M

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Deshmukh, Vikrant G

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Dilip, Deepika

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Ellerbeck, Edward F

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Goldstein, Adam O

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Iturrate, Eduardo

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Jose, Thulasee

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Khanna, Niharika

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King, Andrea

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Klass, Elizabeth

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Mermelstein, Robin J

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Tong, Elisa

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Tsoh, Janice Y

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Wilson, Karen M

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Theobald, Wendy E

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Fiore, Michael C

dc.date.accessioned

2022-11-01T13:43:16Z

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2022-11-01T13:43:16Z

dc.date.issued

2022-09

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2022-11-01T13:43:14Z

dc.description.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.
dc.identifier

6693781

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1462-2203

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1469-994X

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https://hdl.handle.net/10161/26137

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

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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

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ntac201

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Duke

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School of Medicine

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Clinical Science Departments

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Institutes and Centers

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Medicine

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Medicine, General Internal Medicine

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Duke Cancer Institute

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