Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 3;7(6):e2417977.
doi: 10.1001/jamanetworkopen.2024.17977.

Cannabis, Tobacco Use, and COVID-19 Outcomes

Nicholas B Griffith  1 , Timothy B Baker  2 , Brendan T Heiden  3   4 , Nina Smock  5 , Giang Pham  5 , Jingling Chen  5 , Justin Yu  1 , James Reddy  5 , Albert M Lai  1 , Eric Hogue  1 , Laura J Bierut  5 , Li-Shiun Chen  5   6
Affiliations

Cannabis, Tobacco Use, and COVID-19 Outcomes

Nicholas B Griffith et al. JAMA Netw Open. .

Erratum in

  • Error in Figure.
    [No authors listed] [No authors listed] JAMA Netw Open. 2024 Jul 1;7(7):e2427937. doi: 10.1001/jamanetworkopen.2024.27937. JAMA Netw Open. 2024. PMID: 39008304 Free PMC article. No abstract available.

Abstract

Importance: It is unclear whether cannabis use is associated with adverse health outcomes in patients with COVID-19 when accounting for known risk factors, including tobacco use.

Objective: To examine whether cannabis and tobacco use are associated with adverse health outcomes from COVID-19 in the context of other known risk factors.

Design, setting, and participants: This retrospective cohort study used electronic health record data from February 1, 2020, to January 31, 2022. This study included patients who were identified as having COVID-19 during at least 1 medical visit at a large academic medical center in the Midwest US.

Exposures: Current cannabis use and tobacco smoking, as documented in the medical encounter.

Main outcomes and measures: Health outcomes of hospitalization, intensive care unit (ICU) admission, and all-cause mortality following COVID-19 infection. The association between substance use (cannabis and tobacco) and these COVID-19 outcomes was assessed using multivariable modeling.

Results: A total of 72 501 patients with COVID-19 were included (mean [SD] age, 48.9 [19.3] years; 43 315 [59.7%] female; 9710 [13.4%] had current smoking; 17 654 [24.4%] had former smoking; and 7060 [9.7%] had current use of cannabis). Current tobacco smoking was significantly associated with increased risk of hospitalization (odds ratio [OR], 1.72; 95% CI, 1.62-1.82; P < .001), ICU admission (OR, 1.22; 95% CI, 1.10-1.34; P < .001), and all-cause mortality (OR, 1.37, 95% CI, 1.20-1.57; P < .001) after adjusting for other factors. Cannabis use was significantly associated with increased risk of hospitalization (OR, 1.80; 95% CI, 1.68-1.93; P < .001) and ICU admission (OR, 1.27; 95% CI, 1.14-1.41; P < .001) but not with all-cause mortality (OR, 0.97; 95% CI, 0.82-1.14, P = .69) after adjusting for tobacco smoking, vaccination, comorbidity, diagnosis date, and demographic factors.

Conclusions and relevance: The findings of this cohort study suggest that cannabis use may be an independent risk factor for COVID-19-related complications, even after considering cigarette smoking, vaccination status, comorbidities, and other risk factors.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Baker reported holding a chair endowed by Glaxo Wellcome and receiving grants from the National Cancer Institute outside the submitted work. Dr Heiden reported receiving personal fees from Oncocyte Corp and Eli Lilly and Co outside the submitted work. Dr Lai reported being a shareholder in Johnson & Johnson and Altria Group outside the submitted work. Dr Bierut reported receiving grants from the National Institutes of Health during the conduct of the study; in addition, Dr Bierut has a patent for US Patent 8,080,371, “Markers for Addiction.” No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Tobacco Smoking and COVID-19 Outcomes of Hospitalization, Intensive Care Unit (ICU) Admission, and Mortality
Box sizes indicate patient groups from smallest (never smoking) to largest (current smoking). NA indicates not applicable; OR, odds ratio.
Figure 2.
Figure 2.. Association of Tobacco Smoking and COVID-19–Related Hazard of Mortality, Stratified by Age
Shaded areas indicate 95% CIs.
Figure 3.
Figure 3.. Cannabis Use and COVID-19 Outcomes
Box sizes indicate patient groups, with smallest indicating cannabis nonuse and largest indicating cannabis use. NA indicates not applicable; OR, odds ratio.
See this image and copyright information in PMC

References

    1. US Centers for Disease Control and Prevention . COVID data tracker. Accessed February 22, 2022. https://covid.cdc.gov/covid-data-tracker
    1. Zhou Y, Yang Q, Chi J, et al. . Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: a systematic review and meta-analysis. Int J Infect Dis. 2020;99:47-56. doi:10.1016/j.ijid.2020.07.029 - DOI - PMC - PubMed
    1. Li Y, Ashcroft T, Chung A, et al. . Risk factors for poor outcomes in hospitalised COVID-19 patients: a systematic review and meta-analysis. J Glob Health. 2021;11:10001. doi:10.7189/jogh.11.10001 - DOI - PMC - PubMed
    1. Simons D, Shahab L, Brown J, Perski O. The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: a living rapid evidence review with bayesian meta-analyses (version 7). Addiction. 2021;116(6):1319-1368. doi:10.1111/add.15276 - DOI - PMC - PubMed
    1. Hopkinson NS, Rossi N, El-Sayed Moustafa J, et al. . Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people. Thorax. 2021;76(7):714-722. doi:10.1136/thoraxjnl-2020-216422 - DOI - PubMed

Publication types