Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case-control study

Surekha Kishore; Vandana Shah; Om Prakash Bera; U Venkatesh; Rakesh Kakkar; Pradeep Aggarwal; Pankaj Bhardwaj; C M Singh; Chetna Maliye; Suneela Garg; Geetha R Menon; Puneet Misra; Shival Kishore Verma; COVID SHS Study Group

doi:10.3389/fpubh.2023.1210102

Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case-control study

Front Public Health. 2023 Aug 3:11:1210102. doi: 10.3389/fpubh.2023.1210102. eCollection 2023.

Authors

Collaborators

COVID SHS Study Group:
D K Srivastava, Anuj Mundra, Amey Dhatrak, Mahendra Singh Gehlot, Yogesh Bahurupi, Santosh Kumar Nirala, Mahendra Pratap Singh, Arvind Kumar Jaiswal

Affiliations

¹ All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India.
² Campaign for Tobacco-Free Kids, New Delhi, India.
³ Global Health Advocacy Incubator, New Delhi, India.
⁴ Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India.
⁵ Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India.
⁶ Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
⁷ Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
⁸ Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India.
⁹ Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India.
¹⁰ Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India.
¹¹ ICMR-National Institute of Medical Statistics, New Delhi, India.
¹² Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
¹³ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.

Abstract

Introduction: Exposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.

Methodology: Multicentric case-control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).

Results: A total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29-4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43-3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.

Discussion: The results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.

Keywords: COVID-19; secondhand smoke; smoking; substance abuse; vaccination.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
COVID-19 Vaccines
COVID-19* / epidemiology
Case-Control Studies
Humans
Tobacco Smoke Pollution* / adverse effects

Substances

COVID-19 Vaccines
Tobacco Smoke Pollution

Grants and funding

This study was funded by the Campaign for Tobacco-Free Kids. The Campaign for Tobacco-Free Kids is a leading organization working to reduce tobacco use and its devastating health and economic consequences in the United States and around the world.