Ellerbeck, Edward F.
https://orcid.org/0000-0002-7774-2729
Mayo Clinic
University of Kansas Medical Center
Citations 1
Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study
Piasecki, Thomas M. , Smith, Stevens S. , Slutske, Wendy S., Adsit, Robert T. , Conner, Karen L. , Eng, Oliver D., Lazuk, David , Gonzalez, Alec , Jorenby, Douglas E. , D’Angelo, Heather , Kirsch, Julie A. , Williams, Brian , Hayes-Birchler, Todd , Kent, Sean , Kim, Hanna , Lubanski, Stan, Cai, Yuxin , Kashyap, Nitu , Mathew, Jomol , McMahan, Gabriel , Rolland, Betsy , Tindle, Hilary A. , Warren, Graham , An, Lawrence C. , Boyd, Andrew D. , Brunzell, Darlene H., Carrillo, Victor A. , Chen, Li‐Shiun , Davis, James M. , Deshmukh, Vikrant , Dilip, Deepika , Ellerbeck, Edward F. , Jose, Thulasee , Klass, Elizabeth , Tong, Elisa K. , Tsoh, Janice Y. , Wilson, Karen M. , Theobald, Wendy E. , Kent, Sean , Kim, Hanna , Khanna, Niharika , Klass, Elizabeth , Mermelstein, Robin J , Tong, Elisa , Tsoh, Janice Y , Piasecki, Thomas M , Smith, Stevens S , Conner, Karen L , Boyd, Andrew D , Davis, James M , Jose, Thulasee , Baker, Timothy B. , Bolt, Daniel M. , Bernstein, Steven L. , Eng, Oliver D, Nolan, Margaret , Yu, Menggang , Suk, Youmi , Goldstein, Adam O , Iturrate, Eduardo , King, Andrea , Fiore, Michael C.
Nicotine and Tobacco Research | September 7, 2022 | Volume: 25 | Issue: 6 | Pages: 1184-1193
AbstractIntroductionAvailable 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.