Background Smoking impairs lung immune function and damages upper airways, increasing risks of contracting and severity of infectious diseases. This paper quantifies the association between smoking and COVID-19 disease progression. Methods We searched PubMed and Embase for studies published from January 1–May 25, 2020. We included studies reporting smoking behavior of COVID-19 patients and progression of disease, including death. We used random effects meta-analysis, meta-regression and locally weighted regression and smoothing to examine relationships in the data. Results We identified 46 peer-reviewed papers with a total of 22,939 COVID-19 patients, 5421 (23.6%) experienced disease progression and 2914 (12.7%) with a history of smoking (current and former smokers). Among those with a history of smoking, 33.5% experienced disease progression, compared with 21.9% of non-smokers. The meta-analysis confirmed an association between ever smoking and COVID-19 progression (OR 1.59, 95% CI 1.33–1.89, p = 0.001). Ever smoking was associated with increased risk of death from COVID-19 (OR 1.19, 95% CI 1.02–1.39, p = 0.003). We found no significant difference ( p = 0.864) between the effects of ever smoking on COVID-19 disease progression between adjusted and unadjusted analyses, suggesting that smoking is an independent risk factor for COVID-19 disease progression. We also found the risk of having COVID-19 progression higher among younger adults ( p = 0.001), with the effect most pronounced among younger adults under about 45 years old. Conclusions Smoking is an independent risk for having progression of COVID-19, including mortality. The effects seem to be higher among young people. Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11579-x.
【저자키워드】 COVID-19, Meta-analysis, coronavirus, Disease progression, death, Odds ratio, Age effect, 【초록키워드】 public health, Diseases, Mortality, COVID-19 pandemic, severity, lung, risk, progression, smoking, meta-regression, COVID-19 disease, immune function, Physicians, COVID-19 patients, Smokers, association, COVID-19 patient, upper airways, COVID-19 progression, supplementary material, 95% CI, no significant difference, increased risk, progression of disease, independent risk factor, professional, random effect, Effect, independent, Result, adjusted, searched, analyses, impair, peer-reviewed, 【제목키워드】 systematic review, outcome,