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Smoking
Original research
Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people
  1. Nicholas S Hopkinson1,
  2. Niccolo Rossi2,
  3. Julia El-Sayed_Moustafa2,
  4. Anthony A Laverty3,
  5. Jennifer K Quint4,
  6. Maxim Freidin5,
  7. Alessia Visconti2,
  8. Ben Murray6,
  9. Marc Modat6,
  10. Sebastien Ourselin7,
  11. Kerrin Small2,
  12. Richard Davies8,
  13. Jonathan Wolf8,
  14. Tim D Spector2,
  15. Claire J Steves2,
  16. Mario Falchi2
  1. 1 National Heart and Lung Institute, Imperial College London, London, UK
  2. 2 The Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
  3. 3 Department Primary Care and Public Health, Imperial College, London, UK
  4. 4 Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
  5. 5 Department of Twin Research, King's College London, London, UK
  6. 6 School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
  7. 7 Biomedical Engineering & Imaging Sciences, King's College London, London, UK
  8. 8 Zoe Global Limited, London, UK
  1. Correspondence to Dr Nicholas S Hopkinson, National Heart and Lung Institute, Imperial College London, London SW3 6NP, UK; n.hopkinson{at}ic.ac.uk

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.

  • tobacco and the lung
  • viral infection
  • respiratory infection
  • clinical epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. Anonymised research data will be shared with third parties via the centre for Health Data Research UK (HDRUK.ac.uk). Data updates can be found on https://COVID.joinzoe.com.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/thoraxjnl-2020-216422

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Anonymised research data will be shared with third parties via the centre for Health Data Research UK (HDRUK.ac.uk). Data updates can be found on https://COVID.joinzoe.com.

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    Footnotes

    • NSH and NR are joint first authors.

    • Twitter @COPDdoc

    • CJS and MF contributed equally.

    • Correction notice This article has been corrected since it was published Online First. Figures 2 and 4 were interchanged and figure legends for figures 2 and 3 were also listed with the incorrect figure.

    • Contributors NSH, CJS and MF conceived the analysis which was developed with input from all authors. Symptom data cleaning and analyses were performed by BM, MM, SO, NR and MF. NSH, NR and MF produced the first draft of the paper to which all authors contributed. All authors have reviewed and approved the final version. MF is the guarantor.

    • 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.

    • Competing interests NSH is Chair of Action on Smoking and Health and Medical Director of The British Lung Foundation. TDS is a consultant to Zoe Global Ltd (Zoe), who developed the app. JW and RD are employees of Zoe Global Ltd.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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