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Slutske WS, Conner KL, Kirsch JA, Smith SS, Piasecki TM, Johnson AL, McCarthy DE, Nez Henderson P, Fiore MC. Explaining COVID-19 related mortality disparities in American Indians and Alaska Natives. Sci Rep 2023; 13:20974. [PMID: 38017023 PMCID: PMC10684501 DOI: 10.1038/s41598-023-48260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023] Open
Abstract
American Indian and Alaska Native (AI/AN) individuals are more likely to die with COVID-19 than other groups, but there is limited empirical evidence to explain the cause of this inequity. The objective of this study was to determine whether medical comorbidities, area socioeconomic deprivation, or access to treatment can explain the greater COVID-19 related mortality among AI/AN individuals. The design was a retrospective cohort study of harmonized electronic health record data of all inpatients with COVID-19 from 21 United States health systems from February 2020 through January 2022. The mortality of AI/AN inpatients was compared to all Non-Hispanic White (NHW) inpatients and to a matched subsample of NHW inpatients. AI/AN inpatients were more likely to die during their hospitalization (13.2% versus 7.1%; odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.48, 2.65) than their matched NHW counterparts. After adjusting for comorbidities, area social deprivation, and access to treatment, the association between ethnicity and mortality was substantially reduced (OR 1.59, 95% CI 1.15, 2.22). The significant residual relation between AI/AN versus NHW status and mortality indicate that there are other important unmeasured factors that contribute to this inequity. This will be an important direction for future research.
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Affiliation(s)
- Wendy S Slutske
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Conner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Julie A Kirsch
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas M Piasecki
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Adrienne L Johnson
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Michael C Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Kirsch JA, Slutske WS, McCarthy DE, Smith SS, Williams BS, Piasecki TM, Conner KL, Fiore MC. Factors associated with 60-day readmission among inpatients with COVID-19 at 21 United States health systems. J Med Virol 2023; 95:e28972. [PMID: 37475507 DOI: 10.1002/jmv.28972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/30/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
Identifying patients at risk for readmission after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could facilitate care planning and prevention. This retrospective cohort study of 60-day readmission included 105 543 COVID-19 patients at 21 US healthcare systems who were discharged alive between February 2020 and November 2021. Generalized linear mixed regression analyses tested predictors of 60-day readmission and severity. The all-cause readmission rate was 15% (95% confidence interval [CI] = 10%-21%), with 22% (95% CI = 18%-26%) of readmitted patients needing intensive care, and 6% (95% CI = 05%-07%) dying. Factors associated with readmission included male sex, government insurance, positive smoking history, co-morbidity burden, longer index admissions, and diagnoses at index admission (e.g., cancer, chronic kidney disease, and liver disease). Death and intensive care rates at readmission declined postvaccine availability. Receiving at least two COVID-19 vaccine doses, which were more common among older patients and those with comorbid conditions, was not independently associated with readmission but predicted a reduced risk of death at readmission. This retrospective cohort study identified factors associated with all-cause readmission for patients re-admitted to the same health system after hospitalization with SARS-CoV-2 infection. Patients who are male, who smoke, who have a higher comorbidity burden, and have government insurance may benefit from additional postacute care planning.
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Affiliation(s)
- Julie A Kirsch
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Wendy S Slutske
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Brian S Williams
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Thomas M Piasecki
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Karen L Conner
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Christiansen B, Riemer D, Conner KL, Fiore MC. The Bucket Approach: Developing and Implementing an On-line Training Program in Tobacco Dependence Interventions Tailored for Behavioral Health Clinicians. Community Ment Health J 2023; 59:439-450. [PMID: 36050593 PMCID: PMC9436731 DOI: 10.1007/s10597-022-01021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/14/2022] [Indexed: 11/03/2022]
Abstract
People coping with a mental illness and/or addictive disorders have a very high prevalence of smoking cigarettes. The Bucket Approach, a free online training, tailors evidence-based tobacco dependence interventions for behavioral health clinicians to increase the likelihood that they will also address the tobacco use of their patients. From October 2019 through August 2021, 999 people enrolled in and 447 people completed the training. Individuals who completed the training evaluated it highly with an overall mean score of 8.4 (scale = 1 for very poor to 10 for very good). 3- and 6-month follow-up surveys documented continued impact. The training resulted in substantial changes in beliefs about treating tobacco dependence. For example, before training, 18.3% of trainees strongly agreed with the statement, "The skills currently possessed by behavioral health clinicians can be easily applied to the treatment of tobacco dependence." This increased to 40.7% at the end of training.
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Affiliation(s)
- Bruce Christiansen
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St., Suite 200, Madison, WI 53711 USA
| | - Donna Riemer
- WI Department Health Services, Bureau of Prevention Treatment and Recovery, 1 West Wilson Street, Madison, WI 53703 USA
| | - Karen L. Conner
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St., Suite 200, Madison, WI 53711 USA
| | - Michael C. Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St., Suite 200, Madison, WI 53711 USA
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Nolan MB, Piasecki TM, Smith SS, Baker TB, Fiore MC, Adsit RT, Bolt DM, Conner KL, Bernstein SL, Eng OD, Lazuk D, Gonzalez A, Hayes-Birchler T, Jorenby DE, D'Angelo H, Kirsch JA, Williams BS, Kent S, Kim H, Lubanski SA, Yu M, Suk Y, Cai Y, Kashyap N, Mathew J, McMahan G, Rolland B, Tindle HA, Warren GW, Abu-el-rub N, An LC, Boyd AD, Brunzell DH, Carrillo VA, Chen LS, Davis JM, Deshmukh VG, Dilip D, Goldstein AO, Ha PK, Iturrate E, Jose T, Khanna N, King A, Klass E, Lui M, Mermelstein RJ, Poon C, Tong E, Wilson KM, Theobald WE, Slutske WS. Relations of Current and Past Cancer with Severe Outcomes among 104,590 Hospitalized COVID-19 Patients: The COVID EHR Cohort at the University of Wisconsin. Cancer Epidemiol Biomarkers Prev 2023; 32:12-21. [PMID: 35965473 PMCID: PMC9827105 DOI: 10.1158/1055-9965.epi-22-0500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/29/2022] [Accepted: 08/08/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is mixed evidence about the relations of current versus past cancer with severe COVID-19 outcomes and how they vary by patient and cancer characteristics. METHODS Electronic health record data of 104,590 adult hospitalized patients with COVID-19 were obtained from 21 United States health systems from February 2020 through September 2021. In-hospital mortality and ICU admission were predicted from current and past cancer diagnoses. Moderation by patient characteristics, vaccination status, cancer type, and year of the pandemic was examined. RESULTS 6.8% of the patients had current (n = 7,141) and 6.5% had past (n = 6,749) cancer diagnoses. Current cancer predicted both severe outcomes but past cancer did not; adjusted odds ratios (aOR) for mortality were 1.58 [95% confidence interval (CI), 1.46-1.70] and 1.04 (95% CI, 0.96-1.13), respectively. Mortality rates decreased over the pandemic but the incremental risk of current cancer persisted, with the increment being larger among younger vs. older patients. Prior COVID-19 vaccination reduced mortality generally and among those with current cancer (aOR, 0.69; 95% CI, 0.53-0.90). CONCLUSIONS Current cancer, especially among younger patients, posed a substantially increased risk for death and ICU admission among patients with COVID-19; prior COVID-19 vaccination mitigated the risk associated with current cancer. Past history of cancer was not associated with higher risks for severe COVID-19 outcomes for most cancer types. IMPACT This study clarifies the characteristics that modify the risk associated with cancer on severe COVID-19 outcomes across the first 20 months of the COVID-19 pandemic. See related commentary by Egan et al., p. 3.
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Affiliation(s)
- Margaret B. Nolan
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas M. Piasecki
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stevens S. Smith
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Timothy B. Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael C. Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Robert T. Adsit
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Daniel M. Bolt
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Karen L. Conner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Steven L. Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Oliver D. Eng
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David Lazuk
- Yale-New Haven Health System, New Haven, Connecticut
| | - Alec Gonzalez
- BlueTree Network, a Tegria Company, Madison, Wisconsin
| | - Todd Hayes-Birchler
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Douglas E. Jorenby
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Heather D'Angelo
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Julie A. Kirsch
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Brian S. Williams
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sean Kent
- Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Hanna Kim
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Youmi Suk
- School of Data Science, University of Virginia, Charlottesville, Virginia
| | - Yuxin Cai
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nitu Kashyap
- Yale-New Haven Health System, New Haven, Connecticut
- Yale School of Medicine, New Haven, Connecticut
| | - Jomol Mathew
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gabriel McMahan
- Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Betsy Rolland
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Hilary A. Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Graham W. Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Noor Abu-el-rub
- Center for Medical Informatics and Enterprise Analytics, University of Kansas Medical Center, Kansas City, Kansas
| | - Lawrence C. An
- Division of General Medicine, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Andrew D. Boyd
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | | | - Victor A. Carrillo
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey
| | - Li-Shiun Chen
- Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - James M. Davis
- Duke Cancer Institute and Duke University Department of Medicine, Durham, North Carolina
| | | | - Deepika Dilip
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adam O. Goldstein
- Department of Family Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Patrick K. Ha
- Division of Head and Neck Surgical Oncology, University of California San Francisco, San Francisco, California
| | | | - Thulasee Jose
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Niharika Khanna
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Elizabeth Klass
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michelle Lui
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robin J. Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Chester Poon
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elisa Tong
- Department of Internal Medicine, University of California Davis, Davis, California
| | - Karen M. Wilson
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Wendy E. Theobald
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Corresponding Author: Wendy S. Slutske, UW Center for Tobacco Research and Intervention, 1930 Monroe Street #200, Madison, WI 53711. Phone: 608-262-8673; E-mail:
| | - Wendy S. Slutske
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Corresponding Author: Wendy S. Slutske, UW Center for Tobacco Research and Intervention, 1930 Monroe Street #200, Madison, WI 53711. Phone: 608-262-8673; E-mail:
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5
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Fiore MC, Smith SS, Adsit RT, Bolt DM, Conner KL, Bernstein SL, Eng OD, Lazuk D, Gonzalez A, Jorenby DE, D’Angelo H, Kirsch JA, Williams B, Nolan MB, Hayes-Birchler T, Kent S, Kim H, Piasecki TM, Slutske WS, Lubanski S, Yu M, Suk Y, Cai Y, Kashyap N, Mathew JP, McMahan G, Rolland B, Tindle HA, Warren GW, An LC, Boyd AD, Brunzell DH, Carrillo V, Chen LS, Davis JM, Dilip D, Ellerbeck EF, Iturrate E, Jose T, Khanna N, King A, Klass E, Newman M, Shoenbill KA, Tong E, Tsoh JY, Wilson KM, Theobald WE, Baker TB. The first 20 months of the COVID-19 pandemic: Mortality, intubation and ICU rates among 104,590 patients hospitalized at 21 United States health systems. PLoS One 2022; 17:e0274571. [PMID: 36170336 PMCID: PMC9518859 DOI: 10.1371/journal.pone.0274571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Main objective There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic. Study design and methods University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR test in a 14-day window (+/- 7 days of hospital admission); and (3) health system contact prior to COVID-19 hospitalization. Outcomes assessed were: (1) mortality (primary), (2) endotracheal intubation, and (3) ICU admission. Results and significance The 104,590 hospitalized participants had a mean age of 61.7 years and were 50.4% female, 24% Black, and 56.8% White. Overall risk-standardized mortality (adjusted for age, sex, race, ethnicity, body mass index, insurance status and medical comorbidities) declined from 16% of hospitalized COVID-19 patients (95% CI: 16% to 17%) early in the pandemic (February-April 2020) to 9% (CI: 9% to 10%) later (July-September 2021). Among subpopulations, males (vs. females), those on Medicare (vs. those on commercial insurance), the severely obese (vs. normal weight), and those aged 60 and older (vs. younger individuals) had especially high mortality rates both early and late in the pandemic. ICU admission and intubation rates also declined across these 20 months. Conclusions Mortality, intubation, and ICU admission rates improved markedly over the first 20 months of the pandemic among adult hospitalized COVID-19 patients although gains varied by subpopulation. These data provide important information on the course of COVID-19 and identify hospitalized patient groups at heightened risk for negative outcomes. Trial registration ClinicalTrials.gov Identifier: NCT04506528 (https://clinicaltrials.gov/ct2/show/NCT04506528).
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Affiliation(s)
- Michael C. Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
| | - Stevens S. Smith
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Robert T. Adsit
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Daniel M. Bolt
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Karen L. Conner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Steven L. Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Oliver D. Eng
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - David Lazuk
- Yale-New Haven Health System, New Haven, Connecticut, United States of America
| | - Alec Gonzalez
- BlueTree Network, a Tegria Company, Madison, Wisconsin, United States of America
| | - Douglas E. Jorenby
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Heather D’Angelo
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Julie A. Kirsch
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Brian Williams
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Margaret B. Nolan
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Todd Hayes-Birchler
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Sean Kent
- Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Hanna Kim
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Thomas M. Piasecki
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Wendy S. Slutske
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Stan Lubanski
- United States Census Bureau, Washington, D.C., United States of America
| | - Menggang Yu
- Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Youmi Suk
- Department of Human Development, Teachers College, Columbia University, New York, New York, United States of America
| | - Yuxin Cai
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Nitu Kashyap
- Yale-New Haven Health System, New Haven, Connecticut, United States of America
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Jomol P. Mathew
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Gabriel McMahan
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Betsy Rolland
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Hilary A. Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Graham W. Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Lawrence C. An
- Division of General Medicine, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Andrew D. Boyd
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Darlene H. Brunzell
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Victor Carrillo
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Li-Shiun Chen
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - James M. Davis
- Duke Cancer Institute and Duke University Department of Medicine, Durham, North Carolina, United States of America
| | - Deepika Dilip
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Edward F. Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, Missouri, United States of America
| | - Eduardo Iturrate
- New York University Langone Health, New York, New York, United States of America
| | - Thulasee Jose
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Niharika Khanna
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Andrea King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - Elizabeth Klass
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Michael Newman
- University of Utah, Salt Lake City, Utah, United States of America
| | - Kimberly A. Shoenbill
- Department of Family Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Elisa Tong
- University of California Davis, Davis, California, United States of America
| | - Janice Y. Tsoh
- Department of Psychiatry and Behavioral Sciences, Hellen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, United States of America
| | - Karen M. Wilson
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York, United States of America
| | - Wendy E. Theobald
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Timothy B. Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
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Piasecki TM, Smith SS, Baker TB, Slutske WS, Adsit RT, Bolt DM, Conner KL, Bernstein SL, Eng OD, Lazuk D, Gonzalez A, Jorenby DE, D’Angelo H, Kirsch JA, Williams BS, Nolan MB, Hayes-Birchler T, Kent S, Kim H, Lubanski S, Yu M, Suk Y, Cai Y, Kashyap N, Mathew JP, McMahan G, Rolland B, Tindle HA, Warren GW, An LC, Boyd AD, Brunzell DH, Carrillo V, Chen LS, Davis JM, Deshmukh VG, Dilip D, Ellerbeck EF, Goldstein AO, Iturrate E, Jose T, Khanna N, King A, Klass E, Mermelstein RJ, Tong E, Tsoh JY, Wilson KM, Theobald WE, Fiore MC. Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study. Nicotine Tob Res 2022; 25:1184-1193. [PMID: 36069915 PMCID: PMC9494410 DOI: 10.1093/ntr/ntac201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/05/2022] [Accepted: 08/17/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Available evidence is mixed concerning associations between smoking status and COVID-19 clinical outcomes. Effects of nicotine replacement therapy (NRT) and vaccination status on COVID-19 outcomes in smokers are unknown. METHODS Electronic health record data from 104 590 COVID-19 patients hospitalized February 1, 2020 to September 30, 2021 in 21 U.S. health systems were analyzed to assess associations of smoking status, in-hospital NRT prescription, and vaccination status with in-hospital death and ICU admission. RESULTS Current (n = 7764) and never smokers (n = 57 454) did not differ on outcomes after adjustment for age, sex, race, ethnicity, insurance, body mass index, and comorbidities. Former (vs never) smokers (n = 33 101) had higher adjusted odds of death (aOR, 1.11; 95% CI, 1.06-1.17) and ICU admission (aOR, 1.07; 95% CI, 1.04-1.11). Among current smokers, NRT prescription was associated with reduced mortality (aOR, 0.64; 95% CI, 0.50-0.82). Vaccination effects were significantly moderated by smoking status; vaccination was more strongly associated with reduced mortality among current (aOR, 0.29; 95% CI, 0.16-0.66) and former smokers (aOR, 0.47; 95% CI, 0.39-0.57) than for never smokers (aOR, 0.67; 95% CI, 0.57, 0.79). Vaccination was associated with reduced ICU admission more strongly among former (aOR, 0.74; 95% CI, 0.66-0.83) than never smokers (aOR, 0.87; 95% CI, 0.79-0.97). CONCLUSIONS Former but not current smokers hospitalized with COVID-19 are at higher risk for severe outcomes. SARS-CoV-2 vaccination is associated with better hospital outcomes in COVID-19 patients, especially current and former smokers. NRT during COVID-19 hospitalization may reduce mortality for current smokers. IMPLICATIONS Prior findings regarding associations between smoking and severe COVID-19 disease outcomes have been inconsistent. This large cohort study suggests potential beneficial effects of nicotine replacement therapy on COVID-19 outcomes in current smokers and outsized benefits of SARS-CoV-2 vaccination in current and former smokers. Such findings may influence clinical practice and prevention efforts and motivate additional research that explores mechanisms for these effects.
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Affiliation(s)
- Thomas M Piasecki
- Corresponding Author: Thomas M. Piasecki, PhD, Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St., Suite 200, Madison, WI 53711, USA. Telephone: +1 (608) 262-8673.
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Wendy S Slutske
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Robert T Adsit
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, University of Wisconsin–Madison, Madison, WI, USA
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Karen L Conner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Oliver D Eng
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - David Lazuk
- Yale-New Haven Health System, New Haven, CT, USA
| | - Alec Gonzalez
- BlueTree Network, a Tegria Company, Madison, WI, USA
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Heather D’Angelo
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, WI, USA
| | - Julie A Kirsch
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Brian S Williams
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Margaret B Nolan
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Todd Hayes-Birchler
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Sean Kent
- Department of Statistics, University of Wisconsin–Madison, Madison, WI, USA
| | - Hanna Kim
- Department of Educational Psychology, University of Wisconsin–Madison, Madison, WI, USA
| | | | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Youmi Suk
- Department of Human Development, Teachers College Columbia University, New York, NY, USA
| | - Yuxin Cai
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Nitu Kashyap
- Yale-New Haven Health System, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Jomol P Mathew
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Gabriel McMahan
- Department of Statistics, University of Wisconsin–Madison, Madison, WI, USA
| | - Betsy Rolland
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, WI, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Lawrence C An
- Division of General Medicine, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrew D Boyd
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Victor Carrillo
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Li-Shiun Chen
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - James M Davis
- Duke Cancer Institute and Duke University Department of Medicine, Durham, NC, USA
| | | | - Deepika Dilip
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, MO, USA
| | - Adam O Goldstein
- Department of Family Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Thulasee Jose
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Niharika Khanna
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrea King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Elizabeth Klass
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robin J Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Elisa Tong
- Department of Internal Medicine, University of California Davis, Davis, CA, USA
| | - Janice Y Tsoh
- Department of Psychiatry and Behavioral Sciences, Hellen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Karen M Wilson
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Wendy E Theobald
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
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Lathen LS, Plears ML, Shartle EL, Conner KL, Fiore MC, Christiansen BA. The HUD smoke-free rule: Perceptions of residents post-implementation. Prev Med Rep 2020; 19:101159. [PMID: 32728524 PMCID: PMC7381686 DOI: 10.1016/j.pmedr.2020.101159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/27/2020] [Accepted: 07/04/2020] [Indexed: 11/03/2022] Open
Abstract
The new HUD no smoking policy has had a favorable impact on smokers. The new HUD no smoking policy has reduced second hand smoke exposure. There remain needs for education, policy enforcement and on-site cessation help.
In July 2018, the U.S. Department of Housing and Urban Development (HUD) implemented a new Public health Agency rule prohibiting the use of tobacco in and within 25 feet of HUD housing. A convenience sample of 574 residents living in Milwaukee, Wisconsin multi-unit HUD complexes completed a survey from May through July 2019, designed to assess their perceptions of the new policy and its impact. Knowledge of the policy was strong, although continued educational efforts are needed. Attitudes about the policy were generally positive, although smokers held more negative attitudes than non-smokers. Some residents desired more and fairer policy enforcement. Most residents reported that smoke incursions were reduced post policy compared to pre policy, although such incursions still occurred. The policy has had a favorable health impact on smokers; over 80% made at least one positive change in their smoking, including 6.4% who said the policy motivated them to quit. There was no evidence that residents with mobility challenges were differentially affected by the policy. Overall, the HUD smoke-free policy was well received, reduced self-reported exposure to smoke and led most smokers to make positive changes in their smoking. Additional education on the policy, improved enforcement, and cessation services are needed.
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Affiliation(s)
| | | | - Emile L Shartle
- Wisconsin Department of Health Service's Tobacco Prevention and Control Program, United States
| | - Karen L Conner
- Wisconsin Department of Health Service's Tobacco Prevention and Control Program, United States
| | - Michael C Fiore
- University of Wisconsin, Center for Tobacco Research and Intervention, United States
| | - Bruce A Christiansen
- University of Wisconsin, Center for Tobacco Research and Intervention, United States
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