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Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people

Research output: Contribution to journalArticlepeer-review

Nicholas S Hopkinson, Niccolo Rossi, Julia El-Sayed Moustafa, Anthony A Laverty, Jennifer K Quint, Maxim Freidin, Alessia Visconti, Ben Murray, Marc Modat, Sebastien Ourselin, Kerrin Small, Richard Davies, Jonathan Wolf, Tim D Spector, Claire J Steves, Mario Falchi

Original languageEnglish
Pages (from-to)714-722
Number of pages9
JournalThorax
Volume76
Issue number7
Early online date5 Jan 2021
DOIs
E-pub ahead of print5 Jan 2021
Published1 Jul 2021

Bibliographical note

Funding Information: Funding This work was supported by Zoe Global Limited as well as grants from the Wellcome Trust (212904/Z/18/Z) and the Medical Research Council (MRC)/British Heart Foundation Ancestry and Biological Informative Markers for Stratification of Hypertension (AIMHY; MR/M016560/1). TwinsUK is funded by the Wellcome Trust, Medical Research Council, European Union, Chronic Disease Research Foundation (CDRF), Zoe Global Ltd and the National Institute for Health Research (NIHR)-funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London. JSES, TDS and KSS acknowledge support from the Medical Research Council (MR/M004422/1). This work is supported by BREATHE - The Health Data Research Hub for Respiratory Health [MC_PC_19004]. BREATHE is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Funding Information: This work was supported by Zoe Global Limited as well as grants from the Wellcome Trust (212904/Z/18/Z) and the Medical Research Council (MRC)/British Heart Foundation Ancestry and Biological Informative Markers for Stratification of Hypertension (AIMHY; MR/M016560/1). TwinsUK is funded by the Wellcome Trust, Medical Research Council, European Union, Chronic Disease Research Foundation (CDRF), Zoe Global Ltd and the National Institute for Health Research (NIHR)-funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London. JSES, TDS and KSS acknowledge support from the Medical Research Council (MR/M004422/1). This work is supported by BREATHE - The Health Data Research Hub for Respiratory Health [MC-PC-19004]. BREATHE is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Publisher Copyright: © 2021 Author(s) (or their employer(s)). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Background The association between current tobacco smoking, the risk of developing symptomatic COVID-19 and the severity of illness is an important information gap. Methods UK users of the Zoe COVID-19 Symptom Study app provided baseline data including demographics, anthropometrics, smoking status and medical conditions, and were asked to log their condition daily. Participants who reported that they did not feel physically normal were then asked by the app to complete a series of questions, including 14 potential COVID-19 symptoms and about hospital attendance. The main study outcome was the development of 'classic' symptoms of COVID-19 during the pandemic defined as fever, new persistent cough and breathlessness and their association with current smoking. The number of concurrent COVID-19 symptoms was used as a proxy for severity and the pattern of association between symptoms was also compared between smokers and non-smokers. Results Between 24 March 2020 and 23 April 2020, data were available on 2 401 982 participants, mean (SD) age 43.6 (15.1) years, 63.3% female, overall smoking prevalence 11.0%. 834 437 (35%) participants reported being unwell and entered one or more symptoms. Current smokers were more likely to report symptoms suggesting a diagnosis of COVID-19; classic symptoms adjusted OR (95% CI) 1.14 (1.10 to 1.18); >5 symptoms 1.29 (1.26 to 1.31); >10 symptoms 1.50 (1.42 to 1.58). The pattern of association between reported symptoms did not vary between smokers and non-smokers. Interpretation These data are consistent with people who smoke being at an increased risk of developing symptomatic COVID-19.

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