Association between cigarette smoking patterns and severity of COVID-19: Findings from a study in 15 private Hospitals in Indonesia

INTRODUCTION: Indonesia is ranked fourth among countries with the highest smoking rates and has the highest number of male smokers globally. This study aimed to assess the association between cigarette smoking patterns and the severity of COVID-19 among patients in 15 Indonesian hospitals. METHODS: A cross-sectional study was conducted from April to August 2020 using medical records of 490 COVID-19 patients, including the history of their smoking patterns from 15 private referral hospitals in 5 provinces. The severity was defined based on the Guidelines on the Prevention and Control of COVID-19 issued by the Indonesian Ministry of Health, which was indicated by the care provided to patients, namely outpatient, inpatient, and Intensive Care Unit (ICU) services for mild, moderate, and severe symptoms. Smoking patterns were grouped based on adult tobacco use classifications of the Centers for Disease Control and Prevention (CDC). Univariate and bivariate analyses were performed. RESULTS: The results showed that 69.8% of respondents had not smoked cigarettes, 17.1% were active smokers, and 13.1% were former smokers. A significant difference was seen in the number of cigarettes smoked by patients in the ICU, inpatients, and outpatients, among current smokers and passive smokers (p=0.018 and p=0.005, respectively). Furthermore, there was no significant difference in the severity of COVID-19 among current smokers, former smokers, and non-smokers. The time from when smoking was stopped among former smokers was not associated with the severity of COVID-19. CONCLUSIONS: There was no significant difference in COVID-19 severity between groups of smokers. Passive smoking and the number of cigarettes smoked by smokers daily were associated with the severity of COVID-19. Smoke-free policies should be implemented continuously to protect people from the dangers of secondhand smoke.