Smoking and Risks Contributing to COVID-19 Hospitalization in Washoe County, Nevada, 2020-2021.

Objectives: To investigate the association between smoking behavior and COVID-19 hospitalization, integrating individual and regional factors such as community resilience and social determinants of health (SDOH), addressing gaps in existing research.

Design: Retrospective cohort study utilizing multilevel analytical methods to evaluate the effects of individual smoking status and regional SDOH on COVID-19 hospitalization.

Setting: Washoe County, Nevada, during the first year of the COVID-19 pandemic (March 5, 2020, to April 30, 2021).

Participants: All reported laboratory-positive COVID-19-infected adult residents of Washoe County collected by the Washoe County Health District through mandated disease surveillance for which smoking status was recorded, totaling 10,215 cases after data cleaning.

Main outcome measure: Hospitalization among those with COVID-19 was the primary outcome measure, analyzed in relation to individual smoking status and zip code tabulation area (ZCTA)-level SDOH variables.

Results: The analysis found that individuals infected with COVID-19 who currently and formerly smoked had significantly higher odds of hospitalization compared to those who never had smoked, with odds ratios adjusted for demographics and comorbidities. An increased odds of hospitalization among those with COVID-19 were associated with higher local unemployment, a significant ZCTA-level factor.

Conclusions: Smoking may have increased the odds of hospitalization among those infected with COVID-19, as well as the socioeconomic factor of unemployment. The integration of SDOH into the assessment of health outcomes underscores the need for targeted public health interventions that address both individual behaviors and community-level factors. Future research should continue to explore these factors to inform more effective public health strategies and policy decisions.