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. 2023 Nov 22:68:1606175.
doi: 10.3389/ijph.2023.1606175. eCollection 2023.

The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study

A N Shaaban  1 , F Andersson  1   2 , S Peña  3 , I H Caspersen  4 , C Magnusson  1   2 , N Orsini  1   2 , S Karvonen  3 , P Magnus  4 , M P Hergens  5   6 , M R Galanti  1   2
Affiliations

The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study

A N Shaaban et al. Int J Public Health. .

Abstract

Background: The association between tobacco use and COVID-19 is controversial. During the early course of the pandemic, limited testing prevented studying a wide spectrum of clinical manifestations. Objective: To examine the potential causal association between tobacco use and COVID-19 during the second wave (1 October 2020-30 June 2021) of the pandemic in Stockholm, Sweden. Methods: A population-based cohort study was conducted in the Stockholm region of Sweden, with information on tobacco use collected prior to the pandemic. Adjusted relative risks (RR) of COVID-19 and 95% confidence intervals (CI) were calculated, contrasting current smokers and snus users to non-users of tobacco. Results: Compared with non-users of tobacco, current smokers had a lower risk of COVID-19 (RR 0.78, 95% CI = 0.75-0.81) and of hospitalisation for the disease. Current snus users had a higher risk of COVID-19. Heavy smokers and snus users had longer hospital stays than non-users of tobacco. Conclusion: Tobacco use may have a different impact on the risk of being infected with SARS-CoV-2 and the risk of developing severe clinical manifestations. Further research is needed to determine the underlying mechanisms.

Keywords: COVID-19; Sweden; population-based cohort; smokeless tobacco (snus); smoking.

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Conflict of interest statement

The authors declare that they do not have any conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of participants (The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study, Stockholm, Sweden, 2023).
FIGURE 2
FIGURE 2
Total number of COVID-19-related cases, inpatient and ICU admissions, as well as deaths, in the Stockholm region. Source of data: The Public Health Agency of Sweden. For individuals aged 23 and above between October 2020 and June 2021, excluding those residing in retirement homes (The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study, Stockholm, Sweden, 2023).
FIGURE 3
FIGURE 3
Adjusted Relative Risk (RR) and 95% Confidence Intervals (CI) of diagnosis and severity of COVID-19 for current exclusive smokers compared with non-tobacco users among clients of the public dental care clinics in Stockholm region during the second epidemic wave (1 October 2020–30 June 2021).* Adjusted for sex, age, education, income, occupational risk, country of birth and cohabitation (The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study, Stockholm, Sweden, 2023).
FIGURE 4
FIGURE 4
Adjusted Relative Risk (RR) and 95% Confidence Intervals (CI) of diagnoses of COVID-19 stratified by sex [males (A) and females (B)] for current exclusive snus users compared to non-users of tobacco among clients of the public dental care clinics in Stockholm region during the second pandemic wave (1 October 2020–30 June 2021). * Adjusted for age, education, income, occupational risk, country of birth and cohabitation (The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study, Stockholm, Sweden, 2023).
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