Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study

Thomas M. Piasecki; Stevens S. Smith; Timothy B. Baker; Wendy S. Slutske; Robert T. Adsit; Daniel M. Bolt; Karen L. Conner; Steven L. Bernstein; Oliver D. Eng; David Lazuk; Alec Gonzalez; Douglas E. Jorenby; Heather D'Angelo; Julie A. Kirsch; Brian S. Williams; Margaret B. Nolan; Todd Hayes-Birchler; Sean Kent; Hanna Kim; Stan Lubanski; Menggang Yu; Youmi Suk; Yuxin Cai; Nitu Kashyap; Jomol P. Mathew; Gabriel McMahan; Betsy Rolland; Hilary A. Tindle; Graham W. Warren; Lawrence C. An; Andrew D. Boyd; Darlene H. Brunzell; Victor Carrillo; Li Shiun Chen; James M. Davis; Vikrant G. Deshmukh; Deepika Dilip; Edward F. Ellerbeck; Adam O. Goldstein; Eduardo Iturrate; Thulasee Jose; Niharika Khanna; Andrea King; Elizabeth Klass; Robin J. Mermelstein; Elisa Tong; Janice Y. Tsoh; Karen M. Wilson; Wendy E. Theobald; Michael C. Fiore

doi:10.1093/ntr/ntac201

Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study

Thomas M. Piasecki
, Stevens S. Smith
, Timothy B. Baker
, Wendy S. Slutske
, Robert T. Adsit
, Daniel M. Bolt
, Karen L. Conner
, Steven L. Bernstein
, Oliver D. Eng
, David Lazuk
, Alec Gonzalez
, Douglas E. Jorenby
, Heather D'Angelo
, Julie A. Kirsch
, Brian S. Williams
, Margaret B. Nolan
, Todd Hayes-Birchler
, Sean Kent
, Hanna Kim
, Stan Lubanski

Menggang Yu, Youmi Suk, Yuxin Cai, Nitu Kashyap, Jomol P. Mathew, Gabriel McMahan, Betsy Rolland, Hilary A. Tindle, Graham W. Warren, Lawrence C. An, Andrew D. Boyd, Darlene H. Brunzell, Victor Carrillo, Li Shiun Chen, James M. Davis, Vikrant G. Deshmukh, Deepika Dilip, Edward F. Ellerbeck, Adam O. Goldstein, Eduardo Iturrate, Thulasee Jose, Niharika Khanna, Andrea King, Elizabeth Klass, Robin J. Mermelstein, Elisa Tong, Janice Y. Tsoh, Karen M. Wilson, Wendy E. Theobald, Michael C. Fiore

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

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.

Original language	English
Article number	ntac201
Journal	Nicotine and Tobacco Research
Volume	25
Issue number	6
DOIs	https://doi.org/10.1093/ntr/ntac201
State	Published - 1 Jun 2023
Externally published	Yes

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10.1093/ntr/ntac201

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Piasecki, T. M., Smith, S. S., Baker, T. B., Slutske, W. S., Adsit, R. T., Bolt, D. M., Conner, K. L., Bernstein, S. L., Eng, O. D., Lazuk, D., Gonzalez, A., Jorenby, D. E., D'Angelo, H., Kirsch, J. A., Williams, B. S., Nolan, M. B., Hayes-Birchler, T., Kent, S., Kim, H., ... Fiore, M. C. (2023). 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 and Tobacco Research, 25(6), Article ntac201. https://doi.org/10.1093/ntr/ntac201

@article{2b4866f9e750438a80f4304d00382c00,

title = "Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study",

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.",

author = "Piasecki, \{Thomas M.\} and Smith, \{Stevens S.\} and Baker, \{Timothy B.\} and Slutske, \{Wendy S.\} and Adsit, \{Robert T.\} and Bolt, \{Daniel M.\} and Conner, \{Karen L.\} and Bernstein, \{Steven L.\} and Eng, \{Oliver D.\} and David Lazuk and Alec Gonzalez and Jorenby, \{Douglas E.\} and Heather D'Angelo and Kirsch, \{Julie A.\} and Williams, \{Brian S.\} and Nolan, \{Margaret B.\} and Todd Hayes-Birchler and Sean Kent and Hanna Kim and Stan Lubanski and Menggang Yu and Youmi Suk and Yuxin Cai and Nitu Kashyap and Mathew, \{Jomol P.\} and Gabriel McMahan and Betsy Rolland and Tindle, \{Hilary A.\} and Warren, \{Graham W.\} and An, \{Lawrence C.\} and Boyd, \{Andrew D.\} and Brunzell, \{Darlene H.\} and Victor Carrillo and Chen, \{Li Shiun\} and Davis, \{James M.\} and Deshmukh, \{Vikrant G.\} and Deepika Dilip and Ellerbeck, \{Edward F.\} and Goldstein, \{Adam O.\} and Eduardo Iturrate and Thulasee Jose and Niharika Khanna and Andrea King and Elizabeth Klass and Mermelstein, \{Robin J.\} and Elisa Tong and Tsoh, \{Janice Y.\} and Wilson, \{Karen M.\} and Theobald, \{Wendy E.\} and Fiore, \{Michael C.\}",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s). Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.",

year = "2023",

month = jun,

day = "1",

doi = "10.1093/ntr/ntac201",

language = "English",

volume = "25",

journal = "Nicotine and Tobacco Research",

issn = "1462-2203",

publisher = "Oxford University Press",

number = "6",

}

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 2023, '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 and Tobacco Research, vol. 25, no. 6, ntac201. https://doi.org/10.1093/ntr/ntac201

Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study. / Piasecki, Thomas M.; Smith, Stevens S.; Baker, Timothy B. et al.
In: Nicotine and Tobacco Research, Vol. 25, No. 6, ntac201, 01.06.2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes

T2 - Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study

AU - Piasecki, Thomas M.

AU - Smith, Stevens S.

AU - Baker, Timothy B.

AU - Slutske, Wendy S.

AU - Adsit, Robert T.

AU - Bolt, Daniel M.

AU - Conner, Karen L.

AU - Bernstein, Steven L.

AU - Eng, Oliver D.

AU - Lazuk, David

AU - Gonzalez, Alec

AU - Jorenby, Douglas E.

AU - D'Angelo, Heather

AU - Kirsch, Julie A.

AU - Williams, Brian S.

AU - Nolan, Margaret B.

AU - Hayes-Birchler, Todd

AU - Kent, Sean

AU - Kim, Hanna

AU - Lubanski, Stan

AU - Yu, Menggang

AU - Suk, Youmi

AU - Cai, Yuxin

AU - Kashyap, Nitu

AU - Mathew, Jomol P.

AU - McMahan, Gabriel

AU - Rolland, Betsy

AU - Tindle, Hilary A.

AU - Warren, Graham W.

AU - An, Lawrence C.

AU - Boyd, Andrew D.

AU - Brunzell, Darlene H.

AU - Carrillo, Victor

AU - Chen, Li Shiun

AU - Davis, James M.

AU - Deshmukh, Vikrant G.

AU - Dilip, Deepika

AU - Ellerbeck, Edward F.

AU - Goldstein, Adam O.

AU - Iturrate, Eduardo

AU - Jose, Thulasee

AU - Khanna, Niharika

AU - King, Andrea

AU - Klass, Elizabeth

AU - Mermelstein, Robin J.

AU - Tong, Elisa

AU - Tsoh, Janice Y.

AU - Wilson, Karen M.

AU - Theobald, Wendy E.

AU - Fiore, Michael C.

PY - 2023/6/1

Y1 - 2023/6/1

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85159788829

U2 - 10.1093/ntr/ntac201

DO - 10.1093/ntr/ntac201

M3 - Article

C2 - 36069915

AN - SCOPUS:85159788829

SN - 1462-2203

VL - 25

JO - Nicotine and Tobacco Research

JF - Nicotine and Tobacco Research

IS - 6

M1 - ntac201

ER -

Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study

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