Associations between Tobacco Smoking and Self-Reported SARS-CoV-2/COVID-19 Infections, Disease Severity, and Duration in the German Population

Abstract: Background: Our aim was to assess, in the general German population, the association between tobacco smoking status and self-reported SARS-CoV-2 infection, COVID-19 symptom severity, and symptom duration. Methods: Cross-sectional household survey with face-to-face interviews of representative samples of the German population conducted between 02/2021-04/2022. Associations between smoking status (current, long-term ex-, never) and three self-reported outcomes (corona infection status, symptom severity, and symptom duration) were analysed with regression models, adjusted for a range of potential confounding factors, including vaccination status in a sub-sample. We also ran sensitivity analyses. Results: 872 people reported an infection (5.4 % of 16,028). There was no relevant and statistically significant association between current smoking and long-term ex-smoking compared with never smoking regarding ever being infected with corona (aOR=1.02, 95 %CI=0.86–1.20 and aOR=1.03, 95 %CI=0.83–1.28, respectively), symptom severity (aOR=0.84, 95 %CI=0.59–1.20 and aOR=0.88, 95 %CI=0.55–1.38, respectively), and symptom duration (aβ)=-0.09 months, 95 %CI=-0.45–0.28 and aβ=0.002 months, 95 %CI=-0.48–0.48). Sensitivity analyses examining the interaction between survey wave and smoking status showed that the risk of an infection increased over time, and this increase was higher in current smokers compared with never smokers. Conclusions: In the general German population smokers appear to be as likely to acquire a corona infection as long-term ex- and never smokers.