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Carnicer-Pont D, Fu M, Castellano Y, Tigova O, Driezen P, Quah ACK, Kaai SC, Soriano JB, Vardavas CI, Fong GT, Fernández E. Incidence and Determinants of COVID-19 Among People Who Smoke (2018-2021): Findings From the ITC EUREST-PLUS Spain Surveys. Arch Bronconeumol 2024:S0300-2896(24)00223-0. [PMID: 38944617 DOI: 10.1016/j.arbres.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To estimate the cumulative incidence of COVID-19 and its determinants among a nationally representative sample of adults from Spain who smoke. METHODS This is a prospective cohort study that uses data from two waves (Wave 2 in 2018 and Wave 3 in 2021) of the ITC EUREST-PLUS Spain Survey. At baseline (Wave 1 in 2016), all respondents were adults (aged ≥18) who smoked. In total, 1008 respondents participated in Wave 2, and 570 out of 888 eligible participants were followed up in Wave 3 (64.2%). We estimated the cumulative incidence and the relative risk of COVID-19 (RR) and 95% confidence intervals (CI) during follow-up using self-reported information on sociodemographic, smoking-related and health-related characteristics and identified associated factors using multivariable Poisson models with robust variance adjusted for the independent variables. RESULTS The overall cumulative incidence of self-reported COVID-19 was 5.9% (95% CI: 3.9-8.0%), with no significant differences between males (6.3%; 95% CI: 3.6-9.0%) and females (5.6%; 95% CI: 3.2-8.0%). After adjusting for age, sex, and educational level, COVID-19 incidence was positively associated with moderate nicotine dependence (RR: 2.37; 95% CI: 1.04-5.40) and negatively associated with having a partner who smoked (RR: 0.12; 95% CI: 0.03-0.42), and having friends but not a partner who smoked (RR: 0.28; 95% CI: 0.14-0.56). CONCLUSION The correlates of having had COVID-19 among people who smoke should be considered when tailoring information and targeted non-pharmacological preventive measures.
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Affiliation(s)
- Dolors Carnicer-Pont
- Tobacco Control Unit, Catalan Institute of Oncology - WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain; Centre for Biomedical Research in Respiratory Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology - WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain; Centre for Biomedical Research in Respiratory Diseases, Institute of Health Carlos III, Madrid, Spain; Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Nursing, University of Barcelona, Barcelona, Spain.
| | - Yolanda Castellano
- Tobacco Control Unit, Catalan Institute of Oncology - WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain; Centre for Biomedical Research in Respiratory Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology - WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain; Centre for Biomedical Research in Respiratory Diseases, Institute of Health Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Susan C Kaai
- Department of Psychology, University of Waterloo, Waterloo, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Joan B Soriano
- Centre for Biomedical Research in Respiratory Diseases, Institute of Health Carlos III, Madrid, Spain; Pneumology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Greece; European Network for Smoking and Tobacco Prevention, Brussels, Belgium; Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Canada; Ontario Institute for Cancer Research, Toronto, Canada
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology - WHO Collaborating Centre for Tobacco Control, L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain; Centre for Biomedical Research in Respiratory Diseases, Institute of Health Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Rubinson NG, Fong GT, Gravely S, Quah ACK, Bitan M, Lev Ari S, Rosen LJ. The association between risk perceptions, anxiety, and self-reported changes in tobacco and nicotine product use due to COVID-19 in May-June 2020 in Israel. BMC Public Health 2023; 23:759. [PMID: 37098558 PMCID: PMC10126559 DOI: 10.1186/s12889-023-15351-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 03/01/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Early in the COVID-19 pandemic, reports about a possible protective effect of nicotine on COVID-19 conflicted with messaging by public health organizations about increased risks of COVID-19 due to smoking. The ambiguous information the public received, combined with COVID-19-induced anxiety, may have led to changes in tobacco or other nicotine product use. This study examined changes in use of combustible cigarettes (CCs), nargila (hookah/waterpipe), e-cigarettes, and IQOS and home-smoking behaviors. We also assessed COVID-19 related anxiety and perceptions regarding changes in risk of COVID-19 severity due to smoking. METHODS We used cross-sectional data from a population telephone survey that was conducted in Israel in the early phase of the COVID-19 pandemic (May-June 2020) and included 420 adult (age 18+) individuals who reported having ever used CCs (n = 391), nargila (n = 193), and/or electronic cigarettes (e-cigarettes)/heated tobacco products (e.g., IQOS) (n = 52). Respondents were asked about the effect that COVID-19 had on their nicotine product use (quit/reduced use, no change, increased use). We assessed changes in product use, risk perceptions, and anxiety using adjusted multinomial logistic regression analyses. RESULTS Most respondents did not change their frequency of product use (CCs: 81.0%, nargila: 88.2%, e-cigarettes/IQOS: 96.8%). A small percentage either decreased use (CCs: 7.2%, nargila: 3.2%, e-cigarettes/IQOS:2.4%) or increased use (CCs:11.8%, nargila:8.6%, e-cigarettes/IQOS:+ 0.9%). 55.6% of respondents used a product in the home prior to COVID-19; but during the first lockdown COVID-19 period, a greater percentage increased (12.6%) than decreased (4.0%) their home use. Higher levels of anxiety due to COVID-19 were associated with increased home smoking (aOR = 1.59, 95% CI:1.04-2.42, p = 0.02). Many respondents believed that increased severity of COVID-19 illness was associated with CCs (62.0%) and e-cigarettes/vaping (45.3%), with uncertainty about the association being lower for CCs (20.5%) than for vaping (41.3%). CONCLUSIONS While many respondents believed that nicotine product use (particularly CCs and e-cigarettes) was associated with increased risk of COVID-19 disease severity, the majority of users did not change their tobacco/nicotine use. The confusion about the relationship between tobacco use and COVID-19 calls for clear evidence-based messaging from governments. The association between home smoking and increased COVID-19-related stress suggests the need for campaigns and resources to prevent smoking in the home, particularly during times of stress.
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Affiliation(s)
- Noah G Rubinson
- School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Michal Bitan
- Department of Computer Science, College of Management Academic Studies, Rishon LeZion, Israel
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Shahar Lev Ari
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Laura J Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Lazcano U, Cuadrado-Godia E, Grau M, Subirana I, Martínez-Carbonell E, Boher-Massaguer M, Rodríguez-Campello A, Giralt-Steinhauer E, Fernández-Pérez I, Jiménez-Conde J, Roquer J, Ois Á. Increased COVID-19 Mortality in People With Previous Cerebrovascular Disease: A Population-Based Cohort Study. Stroke 2021; 53:1276-1284. [PMID: 34781706 DOI: 10.1161/strokeaha.121.036257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the study was to determine the association between previous stroke and mortality after coronavirus disease 2019 (COVID-19) according to sex, age groups, and stroke subtypes. METHODS Prospective population-based cohort study including all COVID-19 positive cases between February 1 and July 31, 2020. Comorbidities and mortality were extracted using linked health administration databases. Previous stroke included transient ischemic attack, ischemic stroke, hemorrhagic stroke, spontaneous subarachnoid hemorrhage, and combined stroke for cases with more than one category. Other comorbidities were obesity, diabetes, hypertension, ischemic heart disease, atrial fibrillation, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, cirrhosis, dementia, individual socioeconomic index, and deprivation index. Cases were followed up until December 31, 2020. Primary outcome was mortality of any cause after COVID-19 positivity. Cox proportional regression analysis adjusted for comorbidities was used. Stratified analyses were performed for sex and age (<60, 60-79, and ≥80 years). RESULTS There were 91 629 COVID-19 cases. Previous strokes were 5752 (6.27%), of which 3887 (67.57%) were ischemic, 1237 (21.50%) transient ischemic attack, 255 (4.43%) combined, 203 (3.53%) hemorrhagic, and 170 (2.96%) subarachnoid hemorrhage. There were 9512 deaths (10.38%). Mortality was associated with previous stroke (hazard ratio [HR]=1.12 [95% CI, 1.06-1.18], P<0.001), in both sexes separately (men=1.13 [1.05-1.22], P=0.001; women=1.09 [1.01-1.18], P=0.023), in people <60 years (HR=2.97 [1.97-4.48], P<0.001) and 60 to 79 years (HR=1.32 [1.19-1.48], P<0.001) but not in people ≥80 years (HR=1.02 [0.96-1.09], P=0.437). Ischemic (HR=1.11 [1.05-1.18], P=0.001), hemorrhagic (HR=1.53 [1.20-1.96], P=0.001) and combined (HR=1.31 [1.05-1.63], P=0.016) strokes were associated but not transient ischemic attack. Subarachnoid hemorrhage was associated only in people <60 years (HR=5.73 [1.82-18.06], P=0.003). CONCLUSIONS Previous stroke was associated with a higher mortality in people younger than 80 years. The association occurred for both ischemic and hemorrhagic stroke but not for transient ischemic attack. These data might help healthcare authorities to establish prioritization strategies for COVID-19 vaccination.
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Affiliation(s)
- Uxue Lazcano
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain (U.L., E.C.-G., I.S., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.).,Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Departament de Salut Generalitat de Catalunya, Barcelona, Spain (U.L., E.M.-C., M.B.-M.)
| | - Elisa Cuadrado-Godia
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain (U.L., E.C.-G., I.S., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.).,Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Departament de Salut Generalitat de Catalunya, Barcelona, Spain (U.L., E.M.-C., M.B.-M.).,Neurology Department, Hospital del Mar, CEXS-Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain (E.C.-G., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.)
| | - María Grau
- Consortium for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (M.G., I.S.).,Serra-Húnter Fellow, Department of Medicine, University of Barcelona, Spain (M.G.)
| | - Isaac Subirana
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain (U.L., E.C.-G., I.S., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.).,Consortium for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (M.G., I.S.)
| | | | - Marc Boher-Massaguer
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Departament de Salut Generalitat de Catalunya, Barcelona, Spain (U.L., E.M.-C., M.B.-M.)
| | - Ana Rodríguez-Campello
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain (U.L., E.C.-G., I.S., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.).,Neurology Department, Hospital del Mar, CEXS-Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain (E.C.-G., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.)
| | - Eva Giralt-Steinhauer
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain (U.L., E.C.-G., I.S., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.).,Neurology Department, Hospital del Mar, CEXS-Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain (E.C.-G., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.)
| | - Isabel Fernández-Pérez
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain (U.L., E.C.-G., I.S., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.).,Neurology Department, Hospital del Mar, CEXS-Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain (E.C.-G., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.)
| | - Jordi Jiménez-Conde
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain (U.L., E.C.-G., I.S., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.).,Neurology Department, Hospital del Mar, CEXS-Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain (E.C.-G., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.)
| | - Jaume Roquer
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain (U.L., E.C.-G., I.S., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.).,Neurology Department, Hospital del Mar, CEXS-Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain (E.C.-G., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.)
| | - Ángel Ois
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain (U.L., E.C.-G., I.S., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.).,Neurology Department, Hospital del Mar, CEXS-Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain (E.C.-G., A.R.-C., E.G.-S., I.F.-P., J.J.-C., J.R., A.O.)
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