The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study

Int J Public Health. 2023 Nov 22:68:1606175. doi: 10.3389/ijph.2023.1606175. eCollection 2023.


Background: The association between tobacco use and COVID-19 is controversial. During the early course of the pandemic, limited testing prevented studying a wide spectrum of clinical manifestations. Objective: To examine the potential causal association between tobacco use and COVID-19 during the second wave (1 October 2020-30 June 2021) of the pandemic in Stockholm, Sweden. Methods: A population-based cohort study was conducted in the Stockholm region of Sweden, with information on tobacco use collected prior to the pandemic. Adjusted relative risks (RR) of COVID-19 and 95% confidence intervals (CI) were calculated, contrasting current smokers and snus users to non-users of tobacco. Results: Compared with non-users of tobacco, current smokers had a lower risk of COVID-19 (RR 0.78, 95% CI = 0.75-0.81) and of hospitalisation for the disease. Current snus users had a higher risk of COVID-19. Heavy smokers and snus users had longer hospital stays than non-users of tobacco. Conclusion: Tobacco use may have a different impact on the risk of being infected with SARS-CoV-2 and the risk of developing severe clinical manifestations. Further research is needed to determine the underlying mechanisms.

Keywords: COVID-19; Sweden; population-based cohort; smokeless tobacco (snus); smoking.

MeSH terms

  • COVID-19* / epidemiology
  • Cohort Studies
  • Humans
  • SARS-CoV-2
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Sweden / epidemiology
  • Tobacco Use / epidemiology
  • Tobacco, Smokeless* / adverse effects

Grants and funding

This study was funded by NordForsk grant nr Tobrisk-Cov n. 105544.