Combined and interactive effects of alcohol consumption and smoking on the risk of severe disease and poor clinical outcomes in patients with COVID-19: a multicenter retrospective cohort study

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Public health. 24 Jan 2022;205:6-13. doi: 10.1016/j.puhe.2022.01.013. Online ahead of print.

ABSTRACT

OBJECTIVES: Smoking is an established risk factor for disease severity and adverse effects in patients with COVID-19. Alcohol consumption may also be a potential risk factor for disease severity. However, the combined and interactive effects of alcohol and smoking on COVID-19 have not yet been reported. This study aimed to examine the combined and interactive effects of alcohol consumption and smoking on the risk of severe disease and poor outcome in patients with COVID-19.

STUDY DESIGN: This was a multicenter retrospective cohort study.

METHODS: This study retrospectively examined data from 1399 consecutive hospitalized COVID-19 patients at 43 designated hospitals. Patients were grouped according to different combinations of alcohol consumption and smoking. Multivariate mixed-effects logistic regression models were used to estimate the combined and interactive effects of alcohol consumption and smoking on the risk of severe COVID-19 and poor clinical outcomes.

RESULTS: In the study population, 7.3% were drinkers/smokers, 4.3% were drinkers/non-smokers and 4.9% were non-drinkers/smokers. After controlling for potential confounders, single smokers or drinkers did not show a significantly increased risk of severe COVID-19 or poor clinical outcomes compared to non-drinkers/non-smokers. Additionally, this study did not observe any interactive effects of alcohol consumption and smoking on COVID-19. Drinkers/smokers had a 62% increased risk (odds ratio=1.62, 95% confidence interval: 1.01-2.60) of severe COVID-19, but had no significant increase risk of poor clinical outcomes compared to non-drinkers/non-smokers.

CONCLUSIONS: Combined exposure to alcohol and smoking increases the risk of severe COVID-19, but no direct effect of alcohol or smoking, nor any interaction effect of alcohol and smoking, has been detected.

PMID:35219128 | DOI:10.1016/j.puhe.2022.01.013

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