Correlation Between Adult Tobacco Smoking Prevalence and Mortality of Coronavirus Disease-19 Across the World

Nadya Magfira, Helda Helda


Background: Coronavirus disease 2019 (COVID-19) is a global pandemic spreading worldwide. Limited studies showed that smokers were at higher risk of having severe complications and higher mortality. We aimed to analyze the possible correlation between adult tobacco smoking prevalence and COVID-19 mortality all over the world. Methods: this correlation study involved a linear regression to analyse the correlation between smoking prevalence data in adults and COVID-19 Case Fatality Ratio (CFR) in countries with 1000 confirmed COVID-19 cases on May 3, 2020. Results: seventy-five countries included with median CFR 3.66%. There was no relationship between adult male or female smoking prevalence and COVID-19 mortality in all over the countries. The multivariate analysis showed p-values of 0.823 and 0.910 for male and female smoking prevalence, respectively. However, in lower-middle-income countries (LMIC), there was a positive correlation between the prevalence of adult male smoking with the mortality of COVID-19. Each increment of one percentage of adult male smoking prevalence was associated with increase in COVID-19 CFR by 0.08% (95% CI 0.00%-0.15%, p=0.041). Conclusion: there is correlation between the prevalence of adult male smoking and the CFR of COVID-19 in lower middle-income countries. Based on these findings, strengthening of tobacco control policies is essential to reduce the impact of the COVID-19 pandemic especially in LMIC. This still warrants further studies.


COVID-19; tobacco; smoking; mortality; world


Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92(4):401-02. doi: 10.1002/jmv.25678 [published Online First: 2020/01/18].

Organization WH. Coronavirus disease (COVID-19) Situation Report – 104. World Health Organization; 2020.

Djalante R, Lassa J, Setiamarga D, et al. Review and analysis of current responses to COVID-19 in Indonesia: Period of January to March 2020. Progress in Disaster Science. 2020;6. doi: 10.1016/j.pdisas.2020.100091.

Kluge HHP, Wickramasinghe K, Rippin HL, et al. Prevention and control of non-communicable diseases in the COVID-19 response. Lancet. 2020;395(10238):1678-80. doi: 10.1016/s0140-6736(20)31067-9.

Wang B, Li R, Lu Z, et al. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY). 2020;12(7):6049-57. doi: 10.18632/aging.103000 [published Online First: 2020/04/09].

Guo L, Wei D, Zhang X, et al. Clinical features predicting mortality risk in patients with viral pneumonia: The MuLBSTA score. Frontiers Microbiol. 2019;10. doi: 10.3389/fmicb.2019.02752.

Zhao Q, Meng M, Kumar R, et al. The impact of COPD and smoking history on the severity of COVID-19: A systemic review and meta-analysis. J Med Virol. 2020. doi: 10.1002/jmv.25889 [published Online First: 2020/04/16].

Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-e25. doi: 10.1016/j.jinf.2020.04.021 [published Online First: 2020/04/27].

Guo FR. Smoking links to the severity of COVID-19: An update of a meta-analysis. J Med Virol. 2020. doi: 10.1002/jmv.25967 [published Online First: 2020/05/06].

Changeux JP, Amoura Z, Rey FA, et al. A nicotinic hypothesis for Covid-19 with preventive and therapeutic implications. C R Biol. 2020;343(1):33-9. doi: 10.5802/crbiol.8 [published Online First: 2020/07/29].

Lippi G, Henry BM. Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med. 2020;75:107-08. doi: 10.1016/j.ejim.2020.03.014 [published Online First: 2020/03/21].

Marquizo AB. Tobacco control during the COVID-19 pandemic: how we can help. WHO Farmework convention on tobacco control 2020.

Federation ID. IDF diabetes atlas. 9th edition. International Diabetes Federation; 2019.

Miller A, Reandelar MJ, Fasciglione K, et al. Correlation between universal BCG vaccination policy and reduced mortality for COVID-19. 2020. doi:

Ma Y, Zhao Y, Liu J, et al. Effects of temperature variation and humidity on the death of COVID-19 in Wuhan, China. Science of the total environment 2020;724. doi: 10.1016/j.scitotenv.2020.138226.

Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using Open SAFELY. Nature. 2020;584(7821):430-36. doi: 10.1038/s41586-020-2521-4 [published Online First: 2020/07/09].

Usman MS, Siddiqi TJ, Khan MS, et al. Is there a smoker’s paradox in COVID-19? BMJ Evid Based Med. 2020. doi: 10.1136/bmjebm-2020-111492 [published Online First: 2020/08/14].

Anderson C, Becher H, Winkler V. Tobacco control progress in low and middle income countries in comparison to high income countries. Int J Environment Res Publ Health. 2016;13(10). doi: 10.3390/ijerph13101039.

Silva ALOd, Moreira JC, Martins SR. COVID-19 e tabagismo: uma relação de risco. Cadernos de Saúde Pública. 2020;36(5). doi: 10.1590/0102-311x00072020.

Lang AE, Yakhkind A. Coronavirus disease 2019 and smoking: How and why we implemented a tobacco treatment campaign. Chest. 2020. doi: 10.1016/j.chest.2020.06.013 [published Online First: 2020/06/21].

Kaur G, Lungarella G, Rahman I. SARS-CoV-2 COVID-19 susceptibility and lung inflammatory storm by smoking and vaping. J Inflamm (Lond). 2020;17:21. doi: 10.1186/s12950-020-00250-8 [published Online First: 2020/06/13].

Simet SM, Sisson JH, Pavlik JA, et al. Long-term cigarette smoke exposure in a mouse model of ciliated epithelial cell function. Am J Resp Cell Mol Biol. 2010;43(6):635-40. doi: 10.1165/rcmb.2009-0297OC.

Todt JC, Freeman CM, Brown JP, et al. Smoking decreases the response of human lung macrophages to double-stranded RNA by reducing TLR3 expression. Respir Res. 2013;14:33. doi: 10.1186/1465-9921-14-33 [published Online First: 2013/03/19].

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