Why we think it’s important
Understanding the impact of tobacco and cannabis use on COVID-19 outcomes is crucial for identifying at-risk populations and tailoring public health interventions. With the increasing prevalence of cannabis use and the enduring health burden of smoking, these insights can inform strategies to reduce severe outcomes in future infectious disease outbreaks.
Introduction
The COVID-19 pandemic has prompted significant research into risk factors influencing patient outcomes. Among these, the role of substance use—specifically tobacco and cannabis—has been a topic of growing interest. A recent study examined the association between these substances and adverse health outcomes in COVID-19 patients, accounting for known risk factors like age, comorbidities, and vaccination status.
Study Overview and Key Findings
The study analyzed data from over 72,000 COVID-19 cases documented between February 2020 and January 2022. The sample population was diverse in terms of age, gender, and race. Nearly 70% of cases involved hospitalization, 6.5% required intensive care, and 3.7% resulted in mortality. Comorbid conditions, including obesity, diabetes, and cardiovascular disease, were common among patients.
Tobacco and cannabis use emerged as significant variables affecting outcomes. Among the patients, 13.4% were current smokers, 24.4% were former smokers, and 9.7% reported current cannabis use. The findings revealed distinct patterns in how tobacco and cannabis use influenced hospitalization, ICU admission, and mortality rates.
Tobacco Use and COVID-19 Outcomes
Tobacco smoking, both current and former, was strongly associated with increased risks across all major outcomes. Current smokers faced a 72% higher risk of hospitalization compared to those who never smoked. Former smokers also experienced elevated risks, albeit to a lesser extent. ICU admission rates followed a similar trend, with smoking linked to a 22% to 25% increase in risk.
Mortality outcomes underscored the severe impact of smoking, with both current and former smokers showing over 40% higher odds of death from COVID-19. Interestingly, the risks associated with smoking were more pronounced in older patients, highlighting a vulnerability in this demographic.
Comparisons between current and former smokers indicated that while current smokers had higher hospitalization risks, the differences in ICU admission and mortality were negligible. This suggests that the cumulative effects of smoking over time may be as detrimental as ongoing tobacco use when it comes to COVID-19 outcomes.
Cannabis Use and COVID-19 Outcomes
The study also explored the association between cannabis use and COVID-19 severity. Current cannabis users demonstrated an 80% higher risk of hospitalization and a 27% higher risk of ICU admission compared to non-users, even after adjusting for tobacco use and other factors. However, cannabis use was not significantly linked to mortality, contrasting sharply with the patterns observed for tobacco.
These findings contribute to a relatively limited body of research on cannabis and COVID-19. While some prior studies suggested protective effects of cannabis against severe outcomes, this larger dataset provides evidence of increased risks, particularly for hospitalization and ICU admission.
Broader Implications and Considerations
The study highlights the complexity of understanding substance use as a factor in COVID-19 outcomes. Tobacco use, long associated with respiratory and cardiovascular diseases, unsurprisingly exacerbates the severity of COVID-19. Current and former smokers were also less likely to receive COVID-19 vaccines prior to diagnosis, potentially compounding their risks.
Cannabis use, often perceived as less harmful than tobacco, also showed a notable association with severe COVID-19 outcomes. As cannabis becomes more widely legalized and accessible, understanding its health implications in the context of infectious diseases is increasingly important.
Limitations and Future Directions
While the study provides valuable insights, several limitations should be noted. Data on other forms of substance use, such as vaping and alcohol, were limited in scope and sample size. Although preliminary findings suggest a potential link between these substances and hospitalization, further research is needed to establish robust conclusions. Additionally, the study spanned a two-year period during which the COVID-19 virus evolved, and public health measures fluctuated. These temporal changes may have influenced outcomes and the role of substance use.
The findings underscore the importance of targeted interventions for populations at risk. Smoking cessation programs, in particular, could play a crucial role in reducing the burden of severe COVID-19 outcomes. Similarly, public health messaging around cannabis use should include discussions of potential risks, especially for individuals with preexisting health conditions.
Conclusion
This study adds to the growing understanding of how lifestyle factors like tobacco and cannabis use intersect with infectious diseases such as COVID-19. Tobacco use, both current and former, was consistently associated with worse outcomes, including hospitalization, ICU admission, and mortality. Cannabis use also emerged as a risk factor for hospitalization and ICU admission, though not for mortality.
These findings highlight the need for holistic approaches to public health that consider the interplay between substance use and infectious disease management. Further research will be critical to refining these insights and guiding interventions to improve patient outcomes.
“Cannabis, Tobacco Use, and COVID-19 Outcomes.” (N. B. Griffith, et al., JAMA Netw Open, 2024)
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820235?resultClick=3#google_vignette
