Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people
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Abstract
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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SciScore for 10.1101/2020.05.18.20105288: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study has been approved by the King’s College London Research Ethics Committee REMAS ID 18210, review reference LRS-19/20-18210 and all subscribers provided informed consent.
Consent: The study has been approved by the King’s College London Research Ethics Committee REMAS ID 18210, review reference LRS-19/20-18210 and all subscribers provided informed consent.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable We also excluded women who declared themselves to be pregnant (n=8,680). Table 2: Resources
Software and Algorithms Sentences Resources Subsequently, we tested the correlation between the two matrices … SciScore for 10.1101/2020.05.18.20105288: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study has been approved by the King’s College London Research Ethics Committee REMAS ID 18210, review reference LRS-19/20-18210 and all subscribers provided informed consent.
Consent: The study has been approved by the King’s College London Research Ethics Committee REMAS ID 18210, review reference LRS-19/20-18210 and all subscribers provided informed consent.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable We also excluded women who declared themselves to be pregnant (n=8,680). Table 2: Resources
Software and Algorithms Sentences Resources Subsequently, we tested the correlation between the two matrices using the Mantel test, as implemented in the vegan R package (v. 2.5-6). vegansuggested: (vegan, RRID:SCR_011950)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The use of swab testing for PCR diagnosis of viral infection has limitations with a significant false negative rate. It is possible that non-random differences in the way that tests were conducted (e.g. nasopharyngeal or oropharyngeal swabs) or the temporal relation of testing to the development of symptoms (likely more rapid for healthcare workers for example) could have influenced results29,30. In due course, the question of relative infectivity may be answered based either on surveillance screening or widespread antibody testing. Methodological issues: There are some limitations in what can be inferred from these data. The study uses the development of symptoms to define COVID-19, but it is possible that some of these represented conditions other than COVID-19. Behavioural factors or individual prior expectations may have played a role. Thus smokers may have felt themselves to be at a higher risk of developing COVID-19 making them more likely to report symptoms, thus exaggerating the apparent impact of smoking. Alternatively, non-smokers being in general healthier, might be expected to be more sensitive to changes in their wellbeing making them more likely to report symptoms, thus underestimating the impact of smoking. Participants in the study were self-selected, having chosen to register to use the app. In addition the app was only available on a smartphone raising issues of digital access and digital literacy, so caution is needed about extrapolation to the entire popul...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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