Incidence and case-fatality ratio of COVID-19 infection in relation to tobacco smoking, access to healthcare, poverty, and population demographics in the USA

Abstract

Background: Tobacco smoking has been shown to increase the severity of COVID-19 infection and the risk for intra-tracheal ventilation in smokers. Tobacco smoking exposes the user and nearby individuals to very high concentrations of particulate matter in a short period of time. Genes coding for SARS-CoV-2 have been found adherent to particulate matter which has been linked to COVID-19 related mortality PM2.5. The aim of the study was to observe the incidence of SARS-CoV-2 infection rates in the USA, comparing States differentiated by the degree of smoking bans, exploring a possible link between tobacco smoke-related particulate matter and SARS-CoV-2 transmission.

Methodology: Two groups of USA States, differentiated by the degree of smoking legislative restrictions, had a number of variables compared. Variables related to COVID-19 were obtained from the John Hopkins Coronavirus Resource Centre between the 20th and the 26th September 2020. The degree of smoking bans and the percentage of the smoking population in the USA States were obtained from the websites of the Nonsmokers Rights Foundation and the Centres of Disease Control database respectively. Population characteristics were obtained from databases concerning USA demographics.

Results: The incidence of COVID-19 infection in the States with limited bans on tobacco smoking was 2046/100,000 (sd+/-827) while the infection incidence in States with more restrictive rulings on tobacco smoking was 1660/100,000 (sd+/-686) (p<0.038). The population percentage of smokers in States with minor limitations to smoking was 18.3% (sd+/-3.28), while States with greater smoking restrictions had a smoking population percentage of 15.2% (sd+/-2.68) (p<0.0006). Significant correlations were noted between the percentage of the states’ population which was below the poverty line and access to Healthcare. Population density correlated significantly with the case-fatality ratio (R=0.66 p<0.0001).

Conclusion: States in the USA with high levels of tobacco smoking and limited regulation had significantly higher rates of COVID-19 infection incidences than States with greater smoking restrictions. The State population percentage living in poverty, and access to healthcare were significantly different between both groups of States. Densely populated USA States with partial bans on tobacco smoking, with elevated percentages of the population living in poverty and with limited access to healthcare had high incidences of COVID-19 rates during the time period assessed.