Cannabis, Tobacco Use, and COVID-19 Outcomes
MS Nicholas B Griffith, PhD Timothy B Baker, MD, MPHS Brendan T Heiden, Nina Smock, MPH Giang Pham, Smock, Pham Jingling Chen, MD Justin Yu, BA James Reddy, PhD Albert M Lai, MA Eric Hogue, MD; Laura J Bierut, MD, MPH, ScD Li-Shiun Chen
JAMA Network Open, doi:10.1001/jamanetworkopen.2024.17977
IMPORTANCE It is unclear whether cannabis use is associated with adverse health outcomes in patients with COVID-19 when accounting for known risk factors, including tobacco use. OBJECTIVE To examine whether cannabis and tobacco use are associated with adverse health outcomes from COVID-19 in the context of other known risk factors. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used electronic health record data from February 1, 2020, to January 31, 2022. This study included patients who were identified as having COVID-19 during at least 1 medical visit at a large academic medical center in the Midwest US. EXPOSURES Current cannabis use and tobacco smoking, as documented in the medical encounter. MAIN OUTCOMES AND MEASURES Health outcomes of hospitalization, intensive care unit (ICU) admission, and all-cause mortality following COVID-19 infection. The association between substance use (cannabis and tobacco) and these COVID-19 outcomes was assessed using multivariable modeling. RESULTS A total of 72 501 patients with COVID-19 were included (mean [SD] age, 48.9 [19.3] years; 43 315 [59.7%] female; 9710 [13.4%] had current smoking; 17 654 [24.4%] had former smoking; and 7060 [9.7%] had current use of cannabis). Current tobacco smoking was significantly associated with increased risk of hospitalization (odds ratio [OR], 1.72; 95% CI, 1.62-1.82; P < .001), ICU admission (OR, 1.22; 95% CI, 1.10-1.34; P < .001), and all-cause mortality (OR, 1.37, 95% CI, 1.20-1.57; P < .001) after adjusting for other factors. Cannabis use was significantly associated with increased risk of hospitalization (OR, 1.80; 95% CI, 1.68-1.93; P < .001) and ICU admission (OR, 1.27; 95% CI, 1.14-1.41; P < .001) but not with all-cause mortality (OR, 0.97; 95% CI, 0.82-1.14, P = .69) after adjusting for tobacco smoking, vaccination, comorbidity, diagnosis date, and demographic factors.
CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that cannabis use may be an independent risk factor for COVID-19-related complications, even after considering cigarette smoking, vaccination status, comorbidities, and other risk factors.
infection in a small cohort of college students. 10 We present a potential association between alcohol abuse and increased risk of hospitalization following COVID-19 infection. Notably, further studies are needed, as our findings were limited by small sample sizes and limited documentation within our EHR database.
Limitations This study has limitations. First, the study spanned 24 months (February 2020 to January 2022), which may have included significantly different SARS-CoV-2 disease manifestations due to the emergence of new variants, time-varying policies related to universal masking and lockdowns, and the introduction of the COVID-19 vaccine in December 2020. To reduce this concern, we included date of diagnosis and vaccination before diagnosis in our multivariable models to reduce the confounding effect of different outcomes related to time. However, caution should still be exercised when interpreting our results due to the potential for persistent confounding. Second, EHR data are limited by relying on patient self-report of substance use and subsequent documentation by medical staff. Therefore, substance use data quality within EHR often suffers from variable reporting and missing documentation. The best existing measure in the EHR data, current cannabis use, is a very crude measure without specific details on cannabis type, frequency, or recency. We have tried to reduce this bias by using data from all available hospital encounters. These findings should be..
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'reference-count': 25,
'publisher': 'American Medical Association (AMA)',
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'abstract': '<jats:sec id="ab-zoi240587-4"><jats:title>Importance</jats:title><jats:p>It is unclear '
'whether cannabis use is associated with adverse health outcomes in patients with COVID-19 '
'when accounting for known risk factors, including tobacco use.</jats:p></jats:sec><jats:sec '
'id="ab-zoi240587-5"><jats:title>Objective</jats:title><jats:p>To examine whether cannabis and '
'tobacco use are associated with adverse health outcomes from COVID-19 in the context of other '
'known risk factors.</jats:p></jats:sec><jats:sec id="ab-zoi240587-6"><jats:title>Design, '
'Setting, and Participants</jats:title><jats:p>This retrospective cohort study used electronic '
'health record data from February 1, 2020, to January 31, 2022. This study included patients '
'who were identified as having COVID-19 during at least 1 medical visit at a large academic '
'medical center in the Midwest US.</jats:p></jats:sec><jats:sec '
'id="ab-zoi240587-7"><jats:title>Exposures</jats:title><jats:p>Current cannabis use and '
'tobacco smoking, as documented in the medical encounter.</jats:p></jats:sec><jats:sec '
'id="ab-zoi240587-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Health '
'outcomes of hospitalization, intensive care unit (ICU) admission, and all-cause mortality '
'following COVID-19 infection. The association between substance use (cannabis and tobacco) '
'and these COVID-19 outcomes was assessed using multivariable '
'modeling.</jats:p></jats:sec><jats:sec '
'id="ab-zoi240587-9"><jats:title>Results</jats:title><jats:p>A total of 72\u202f501 patients '
'with COVID-19 were included (mean [SD] age, 48.9 [19.3] years; 43\u202f315 [59.7%] female; '
'9710 [13.4%] had current smoking; 17\u202f654 [24.4%] had former smoking; and 7060 [9.7%] had '
'current use of cannabis). Current tobacco smoking was significantly associated with increased '
'risk of hospitalization (odds ratio [OR], 1.72; 95% CI, 1.62-1.82; '
'<jats:italic>P</jats:italic>\u2009&amp;lt;\u2009.001), ICU admission (OR, 1.22; 95% CI, '
'1.10-1.34; <jats:italic>P</jats:italic>\u2009&amp;lt;\u2009.001), and all-cause mortality '
'(OR, 1.37, 95% CI, 1.20-1.57; <jats:italic>P</jats:italic>\u2009&amp;lt;\u2009.001) after '
'adjusting for other factors. Cannabis use was significantly associated with increased risk of '
'hospitalization (OR, 1.80; 95% CI, 1.68-1.93; <jats:italic>P</jats:italic>\u2009'
'&amp;lt;\u2009.001) and ICU admission (OR, 1.27; 95% CI, 1.14-1.41; '
'<jats:italic>P</jats:italic>\u2009&amp;lt;\u2009.001) but not with all-cause mortality '
'(OR, 0.97; 95% CI, 0.82-1.14, <jats:italic>P</jats:italic>\u2009=\u2009.69) after adjusting '
'for tobacco smoking, vaccination, comorbidity, diagnosis date, and demographic '
'factors.</jats:p></jats:sec><jats:sec id="ab-zoi240587-10"><jats:title>Conclusions and '
'Relevance</jats:title><jats:p>The findings of this cohort study suggest that cannabis use may '
'be an independent risk factor for COVID-19–related complications, even after considering '
'cigarette smoking, vaccination status, comorbidities, and other risk '
'factors.</jats:p></jats:sec>',
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