Risk of death due to COVID-19 among current and former smokers in the Netherlands: a population-based quasi-cohort study.

Publication date: Feb 01, 2024

Research on smoking as a risk factor for death due to COVID-19 remains inconclusive, with different studies demonstrating either an increased or decreased risk of COVID-19 death among smokers. To investigate this controversy, this study uses data from the Netherlands to assess the relationship between smoking and death due to COVID-19. In this population-based quasi-cohort study, we linked pseudonymized individual data on smoking status from the 2016 and 2020 ‘Health Monitor Adults and Elderly’ in the Netherlands (nā€‰=ā€‰914 494) to data from the cause-of-death registry (nā€‰=ā€‰2962). Death due to COVID-19 in 2020 or 2021 was taken as the main outcome. Poisson regression modelling was used to calculate relative risks (RRs) and 95% CIs of death due to COVID-19 for current and former smokers compared with never smokers while adjusting for relevant confounders (age, sex, educational level, body mass index and perceived health). Former smokers had a higher risk of death due to COVID-19 compared with never smokers across unadjusted (RR, 2. 22; 95% CI, 2. 04-2. 42), age-sex-adjusted (RR, 1. 38; 95% CI, 1. 22-1. 55) and fully adjusted (RR, 1. 30; 95% CI, 1. 16-1. 45) models. Current smokers had a slightly higher risk of death due to COVID-19 compared with never smokers after adjusting for age and sex (RR, 1. 21; 95% CI, 1. 00-1. 48) and after full adjustment (RR, 1. 08; 95% CI, 0. 90-1. 29), although the results were statistically non-significant. People with a history of smoking appear to have a higher risk of death due to COVID-19. Further research is needed to investigate which underlying mechanisms may explain this.

Concepts Keywords
Death COVID-19
Models death
Netherlands population research
Smoking smoking status
the Netherlands


Type Source Name
disease MESH death
disease MESH COVID-19
disease VO population
disease MESH educational level
disease IDO history
disease MESH Long Covid

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