Smoking prevalence and COVID-19 in Europe

Tsigaris, Panagiotis; Teixeira da Silva, Jaime A

INTRODUCTION: This ecological study investigates the association between smoking prevalence and COVID-19 occurrence and mortality in 38 European nations as of 30(th) May 2020. METHODS: Data were collected from Our World in Data. Regression analysis was conducted to adjust for potential confounding factors such as economic activity (GDP), the rate of COVID-19 testing, and the stringency of COVID-19 control policies. RESULTS: There was a statistically significant negative association between smoking prevalence and the prevalence of COVID-19 across the 38 European nations after controlling for confounding factors (p = 0.001). A strong association was found between the prevalence of COVID-19 per million people and economic activity (p = 0.002) and the rate of COVID-19 testing (p = 0.0006). Nations with stricter policy enactment showed fewer COVID-19 cases per million people, but the association was not significant (p = 0.122). Delaying policy enactment was associated with a greater prevalence of COVID-19 (p = 0.0535). Evidence of a direct association between smoking prevalence and COVID-19 mortality was not found (p = 0.626). There was a strong positive association between COVID-19 mortality rate and the prevalence of COVID-19 cases (p < 0.0001) as well as the proportion of the population over 65 years of age (p = 0.0034) and a negative association with the rate of COVID-19 testing (p = 0.0023). CONCLUSIONS: We found a negative association between smoking prevalence and COVID-19 occurrence at the population level in 38 European countries. This association may not imply a true or causal relationship, and smoking is not advocated as a prevention or treatment of COVID-19.