Smoking Prevalence and COVID-19 in Europe

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>This ecological study investigates the association between smoking prevalence and COVID-19 occurrence and mortality in 38 European nations as of 30th May 2020.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Data were collected from Our World in Data. Regression analysis was conducted to adjust for potential confounding factors such as economic activity (GDP), the rate of COVID-19 testing, and the stringency of COVID-19 control policies.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>There was a statistically significant negative association between smoking prevalence and the prevalence of COVID-19 across the 38 European nations after controlling for confounding factors (p = 0.001). A strong association was found between the prevalence of COVID-19 per million people and economic activity (p = 0.002) and the rate of COVID-19 testing (p = 0.0006). Nations with stricter policy enactment showed fewer COVID-19 cases per million people, but the association was not significant (p = 0.122). Delaying policy enactment was associated with a greater prevalence of COVID-19 (p = 0.0535). Evidence of a direct association between smoking prevalence and COVID-19 mortality was not found (p = 0.626). There was a strong positive association between COVID-19 mortality rate and the prevalence of COVID-19 cases (p &amp;lt; 0.0001) as well as the proportion of the population over 65 years of age (p = 0.0034) and a negative association with the rate of COVID-19 testing (p = 0.0023).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>We found a negative association between smoking prevalence and COVID-19 occurrence at the population level in 38 European countries. This association may not imply a true or causal relationship, and smoking is not advocated as a prevention or treatment of COVID-19.</jats:p> </jats:sec>

Response to the Comment on “A Systematic Review and Meta-Analysis of Hospitalised Current Smokers and COVID-19”

“…Berlin and Thomas also stated that “none of 20 the included papers reported on biochemical verification of smoking status”. We agree with this assessment and consider that it would be very interesting to include it (biochemical verification and COVID-19) in future reviews when these data are available, especially when most recent studies indicate a negative association between smoking prevalence and occurrence of COVID-19 at the population level in 38 European countries [ 9 ].…”

Policy determinants of COVID-19 pandemic–induced fatality rates across nations

“…The second issue is the potential of missing other important confounding factors (e.g. obesity levels, smoking prevalence 8 ), which could be correlated with the variables of this study. Their omission could cause the estimated coefficients of this study to be biased.…”

Nicotine Changes Airway Epithelial Phenotype and May Increase the SARS-COV2 Infection Severity

“…Indeed, we have recently shown that Nicotine exposure induces rapid and long-lasting increase in gene expression and protein level of ACE2 in low ACE2-expressing human pulmonary adenocarcinoma A549 epithelial cell line, which in turn translates into increased competence for SARS-CoV-2 replication and cytopathic effect [47].Different epidemiological investigations on relationship between smoking (or nicotine) and SARS-CoV-2 have been published or are available as pre-print, and we have recently extensively reviewed these data [48]. Evidence from these studies is somehow contrasting, and the role of tobacco smoking or vaping is still to be assessed [49][50][51][52][53][54][55][56][57][58][59][60]. It is possible to suppose the presence of underreporting or misreporting data in recording smoking history at admission, especially to ICU, during the COVID-19 outbreak, when the hospitals are overwhelmed.…”