Smoking Is Independently Associated With an Increased Risk for COVID-19 Mortality: A Systematic Review and Meta-analysis Based on Adjusted Effect Estimates

Introduction: Smoking can cause mucociliary clearing dysfunction and poor pulmonary immunity, leading to more severe infection. We performed this study to explore the association between smoking and mortality of coronavirus disease 2019 (COVID-19) patients utilizing a quantitative meta-analysis on the basis of adjusted effect estimates. Aims and Methods: We conducted a systematic search of the online databases including PubMed, Web of Science, Scopus, and Embase. Only articles reporting adjusted effect estimates on the association between smoking and the risk of mortality among COVID-19 patients in English were included. Newcastle-Ottawa scale was fitted to assess the risk of bias. A random-effects model was applied to calculate the pooled effect with the corresponding 95% confidence interval (CI). Results: A total of 73 articles with 863 313 COVID-19 patients were included in this meta-analysis. Our results indicated that smoking was significantly associated with an increased risk for death in patients with COVID-19 (pooled relative risk = 1.19, 95% CI = 1.12-1.27). Sensitivity analysis indicated that our results were stable and robust. Conclusions: Smoking was independently associated with an increased risk for mortality in COVID19 patients.

Automated summary

A quantitative meta-analysis revealed a significant association between smoking and mortality of COVID-19 patients, with smoking increasing the risk of death. The study concluded that smoking independently contributes to an increased risk of mortality in COVID-19 patients, with stable and reliable results from sensitivity analysis.