{"doi":"10.32388/ujr2aw.14","title":"The association of smoking status with SARS-CoV-2 infection, hospitalisation and mortality from COVID-19: A living rapid evidence review with Bayesian meta-analyses (version 12)","abstract":"<jats:p>AIMS: To estimate the association of smoking status with rates of i) infection, ii) hospitalisation, iii) disease severity in hospitalised patients, and iv) mortality from SARS-CoV-2/COVID-19 disease.\n\nDESIGN: Living rapid review of observational and experimental studies with random-effects hierarchical Bayesian meta-analyses. Published articles and pre-prints were identified via MEDLINE and medRxiv\n\n.\n\nSETTING: Community or hospital. No restrictions on location.\n\nPARTICIPANTS: Adults who received a SARS-CoV-2 test or a COVID-19 diagnosis.\n\nMEASUREMENTS: Outcomes were SARS-CoV-2 infection, hospitalisation, disease severity and mortality stratified by smoking status. Study quality was assessed (i.e. ‘good,’ ‘fair’ and ‘poor’).\n\nFINDINGS: v12 (searches up to 2021-07-18) included 547 studies with 87 ‘good’ and ‘fair’ quality studies included in unadjusted meta-analyses. 171 studies (31.3%) reported current, former and never smoking status with the remainder using broader categories. Recorded smoking prevalence among people with COVID-19 was generally lower than national prevalence. Current compared with never smokers were at reduced risk of SARS-CoV-2 infection (RR = 0.67, 95% Credible Interval (CrI) = 0.60-0.75, τ = 0.27). Data for former smokers were inconclusive (RR = 0.99, 95% CrI = 0.94-1.05, τ = 0.12) but favoured there being no important association (&lt;1% probability of RR ≥1.1). Former compared with never smokers were at increased risk of hospitalisation (RR = 1.27, CrI = 1.15-1.40, τ = 0.20), greater disease severity (RR = 1.69, CrI = 1.30-2.22, τ = 0.43) and mortality (RR = 1.59, CrI = 1.34-1.89, τ = 0.37). Current compared with never smokers were at increased risk of greater disease severity (RR 1.3, 95% CrI = 1.01-1.71, τ = 0.32). Data for current smokers on hospitalisation and mortality were inconclusive (RR = 1.10, 95% CrI = 0.97-1.24, τ = 0.23; RR = 1.13, 95% CrI = 0.90-1.40, τ = 0.41, respectively) but favoured there being no important associations (50% and 60% probability of RR ≥1.1, respectively).\n\nCONCLUSIONS: Compared with never smokers, current smokers appear to be at reduced risk of SARS-CoV-2 infection and increased risk of greater in-hospital disease severity, while former smokers appear to be at increased risk of hospitalisation, greater in-hospital disease severity and mortality from COVID-19. However, it is uncertain whether these associations are causal. This version (v12) will be the last regular update; however, yearly updates may continue as new evidence becomes available.\n\nv7 of this living review article has been published in _Addiction_ [https://doi.org/10.1111/add.15276]</jats:p>","journal":null,"year":null,"id":638098,"datarank":0.20794415416798362,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.0,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":486720,"name":"Lion Shahab","orcid":"0000-0003-4033-442X","position":1,"is_corresponding":false},{"id":628452,"name":"Jamie Brown","orcid":"0000-0002-2797-5428","position":2,"is_corresponding":false},{"id":480837,"name":"Olga Perski","orcid":"0000-0003-3285-3174","position":3,"is_corresponding":false},{"id":259405,"name":"David Simons","orcid":"0000-0001-9655-1656","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"The association of smoking status with SARS-CoV-2 infection, hospitalisation and mortality from COVID-19: A living rapid evidence review with Bayesian meta-analyses (version 12)","abstract":"<jats:p>AIMS: To estimate the association of smoking status with rates of i) infection, ii) hospitalisation, iii) disease severity in hospitalised patients, and iv) mortality from SARS-CoV-2/COVID-19 disease.\n\nDESIGN: Living rapid review of observational and experimental studies with random-effects hierarchical Bayesian meta-analyses. Published articles and pre-prints were identified via MEDLINE and medRxiv\n\n.\n\nSETTING: Community or hospital. No restrictions on location.\n\nPARTICIPANTS: Adults who received a SARS-CoV-2 test or a COVID-19 diagnosis.\n\nMEASUREMENTS: Outcomes were SARS-CoV-2 infection, hospitalisation, disease severity and mortality stratified by smoking status. Study quality was assessed (i.e. ‘good,’ ‘fair’ and ‘poor’).\n\nFINDINGS: v12 (searches up to 2021-07-18) included 547 studies with 87 ‘good’ and ‘fair’ quality studies included in unadjusted meta-analyses. 171 studies (31.3%) reported current, former and never smoking status with the remainder using broader categories. Recorded smoking prevalence among people with COVID-19 was generally lower than national prevalence. Current compared with never smokers were at reduced risk of SARS-CoV-2 infection (RR = 0.67, 95% Credible Interval (CrI) = 0.60-0.75, τ = 0.27). Data for former smokers were inconclusive (RR = 0.99, 95% CrI = 0.94-1.05, τ = 0.12) but favoured there being no important association (&lt;1% probability of RR ≥1.1). Former compared with never smokers were at increased risk of hospitalisation (RR = 1.27, CrI = 1.15-1.40, τ = 0.20), greater disease severity (RR = 1.69, CrI = 1.30-2.22, τ = 0.43) and mortality (RR = 1.59, CrI = 1.34-1.89, τ = 0.37). Current compared with never smokers were at increased risk of greater disease severity (RR 1.3, 95% CrI = 1.01-1.71, τ = 0.32). Data for current smokers on hospitalisation and mortality were inconclusive (RR = 1.10, 95% CrI = 0.97-1.24, τ = 0.23; RR = 1.13, 95% CrI = 0.90-1.40, τ = 0.41, respectively) but favoured there being no important associations (50% and 60% probability of RR ≥1.1, respectively).\n\nCONCLUSIONS: Compared with never smokers, current smokers appear to be at reduced risk of SARS-CoV-2 infection and increased risk of greater in-hospital disease severity, while former smokers appear to be at increased risk of hospitalisation, greater in-hospital disease severity and mortality from COVID-19. However, it is uncertain whether these associations are causal. This version (v12) will be the last regular update; however, yearly updates may continue as new evidence becomes available.\n\nv7 of this living review article has been published in _Addiction_ [https://doi.org/10.1111/add.15276]</jats:p>","is_dataset_classified":null,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"19767382","pmcid":null,"openalex_id":"https://openalex.org/W4205729348","authors":[],"funders":[{"funder_name":"UK Research and Innovation","grant_id":"MR/S037519/1","title":"UKPRPICA: SPECTRUM: Shaping Public hEalth poliCies To Reduce IneqUalities and harM"}],"total_grants":1,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[{"year":2021,"count":2},{"year":2022,"count":1}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://www.qeios.com/read/UJR2AW.14/pdf","host_type":""},{"url":"https://www.qeios.com/read/UJR2AW.14/pdf","host_type":""},{"url":"https://doi.org/10.32388/ujr2aw.14","host_type":""},{"url":"https://orcid.org/0000-0001-9655-1656>;","host_type":"repository"},{"url":"https://doi.org/10.32388/ujr2aw.15","host_type":""},{"url":"https://www.qeios.com/read/UJR2AW.15/pdf","host_type":""},{"url":"https://dx.doi.org/10.60692/mtkph-k1f63","host_type":""},{"url":"https://dx.doi.org/10.60692/adbm5-xcq85","host_type":""},{"url":"https://dx.doi.org/10.60692/5ew4t-afg82","host_type":""},{"url":"https://dx.doi.org/10.60692/bmfmx-8j536","host_type":""},{"url":"https://researchonline.lshtm.ac.uk/id/eprint/4662798/1/add.15276.pdf","host_type":""},{"url":"https://discovery-pp.ucl.ac.uk/id/eprint/10132997/","host_type":""}],"fields_of_study":["COVID-19 and healthcare impacts","COVID-19 Clinical Research Studies","COVID-19 and Mental Health","03 medical and health sciences","0302 clinical medicine"],"mesh_terms":[],"keywords":["Medicine","Observational study","Relative risk","Meta-analysis","Credible interval","Confidence interval","Coronavirus disease 2019 (COVID-19)","Pandemic","Disease","MEDLINE","Demography","Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)","Internal medicine","Infectious disease (medical specialty)","Economics and Econometrics","FOS: Political science","Social Sciences","FOS: Law","FOS: Health sciences","Coronavirus Disease 2019","Impacts of COVID-19 on Global Economy and Markets","Sociology","Health Sciences","Psychology","Political science","FOS: Sociology","FOS: Psychology","Clinical Psychology","Economics, Econometrics and Finance","Infectious Diseases","Mental Health","Impact of COVID-19 on Mental Health","Law"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. Good health"},{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-06T20:06:34.537691Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}