Smoking and pre-existing co-morbidities as risk factors for developing severity of COVID-19 infection: Evidence from a field hospital in a rural area of Bangladesh

• Published in: PloS one Vol. 18; no. 12; p. e0295040
• Main Authors: Islam, Rashadul, Ahmed, Sayem, Chakma, Samar Kishor, Mahmud, Tareq, Al Mamun, Abdullah, Islam, Ziaul, Islam, M Munirul
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.12.2023; Public Library of Science (PLoS)
• Subjects: Adult; Adults; Asthma; Asthma - complications; Bangladesh - epidemiology; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - complications; Chi-square test; Chronic obstructive pulmonary disease; Comorbidity; Complications and side effects; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - epidemiology; Data analysis; Development and progression; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Female; Health aspects; Heart diseases; Hospital patients; Hospitals; Humans; Hypertension; Hypertension - complications; Hypertension - epidemiology; Hypoxia; Infections; Information management; Lung diseases; Lung diseases, Obstructive; Male; Medical research; Medicine, Experimental; Middle Aged; Mobile Health Units; Morbidity; Multivariate analysis; Pandemics; Patients; Pneumonia; Public health; Pulmonary Disease, Chronic Obstructive; Regression analysis; Regression models; Respiratory distress syndrome; Retrospective Studies; Risk Factors; Rural areas; Rural population; Smoking; Smoking - adverse effects; Smoking - epidemiology; Statistics; Tobacco; Tobacco Smoking; Viral diseases; Young Adult; Bangladesh; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0295040

Since August 2020; the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in collaboration with UNICEF has been operating a COVID-19 field hospital at the Teknaf sub-district of Cox's Bazar in Bangladesh. This paper is focused on estimating the effects of a history of tobacco smoking and pre-existing co-morbidities on the severity of COVID-19 infection among adult patients admitted into the aforesaid hospital. We conducted a retrospective data analysis of COVID-19 adult patients hospitalized from August 27, 2020 to April 20, 2022. Based on inclusion criteria; a total of 788 admitted patients were included in the analysis. We conducted a Chi-squared test and Fisher's exact test for the categorical variables to see their associations. Multinomial logistic regression models were performed to explore the risk factors for the severity of COVID-19 infection. Among 788 patients, 18.4%, 18.8%, 13%, 7.1%, 3.4%, and 1.9% have had a history of smoking, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVD), and asthma respectively. Overall, the mean age of the patients was 40.3 ± 16.4 years and 51% were female. In multivariate analysis, history of smoking and co-morbidities were identified as the risk factors for the severity of COVID-19 infection; the history of smoking was found linked with an increase in the risk of developing critical, severe, and moderate level of COVID-19 infection- notably 3.17 times (RRR = 3.17; 95% CI: 1.3-7.68), 2.98 times (RRR = 2.98; 95% CI: 1.87-4.76) and 1.96 times (RRR = 1.96; 95% CI: 1.25-3.08) respectively more than the patients who never smoked. It was evident that patients with at least one of the selected co-morbidities such as hypertension, diabetes, COPD, CVD, and asthma exhibited a significantly higher likelihood of experiencing severe illness of COVID-19 compared to patients without any co-morbidity. History of tobacco smoking and pre-existing co-morbidities were significantly associated with an increased severity of COVID-19 infection.