Smoking, Vaping Linked to Higher Risk of Severe COVID-19 Complications

Researchers examined data on people over 18 years of age who were hospitalized with COVID-19 in 107 registry-participating hospitals across the nation between January 2020 to March 2021. Smoking status was self-reported and people were classified as smoking if they reported currently using either traditional, combustible cigarettes or e-cigarette products, with no distinction between the two and no information on duration of smoking or former smoking status.

“We established the COVID-19 CVD Registry early on in the pandemic to better understand the link between COVID-19 and cardiovascular disease, specifically, to identify increased risk to help inform the diagnosis and care of people who are at highest risk for complications,” said Sandeep R. Das, M.D., M.P.H., M.B.A., FAHA.

The study findings indicate smoking or vaping are associated with more severe COVID-19 independent of age, sex, race or medical history:

-People who reported smoking were 45% more likely to die and 39% more likely to receive mechanical ventilation when compared with those who did not smoke.

-Although the excessive risk due to smoking was independent of medical history and medication use, smoking was a stronger risk factor for death in people between 18-59 years of age and those who were white or had obesity.

“In general, people who smoke or vape tend to have a higher prevalence of other health conditions and risk factors that could play a role in how they are impacted by COVID-19. However, the robust and significant increase in the risk of severe COVID-19 seen in our study, independent of medical history and medication use and particularly among young individuals, underscores the urgent need for extensive public health interventions such as anti-smoking campaigns and increased access to cessation therapy, especially in the age of COVID,” said the study’s senior author, Aruni Bhatnagar. “These findings provide the clearest evidence to date that people who smoke or vape have a higher risk of developing severe COVID-19 and dying as a result of SARS-CoV-2 infection.”


Ram Poudel, Lori B. Daniels, Andrew P. DeFilippis, Naomi M. Hamburg, Yosef Khan, Rachel J. Keith, Revanthy Sampath Kumar, Andrew C. Strokes, Rose Marie Robertson, Aruni Bhatnagar. Smoking is associated with increased risk of cardiovascular events, disease severity, and mortality among patients hospitalized for SARS-CoV-2 infections. PLOS ONE, 2022; 17 (7): e0270763 DOI: 10.1371/journal.pone.0270763

American Heart Association. “Smoking, vaping linked to higher risk of severe COVID-19 complications, including death.” ScienceDaily. ScienceDaily, 26 July 2022. <>.

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Photo by Andres Siimon