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Cigarette smoking and the occurrence of influenza – Systematic review

  • H. Lawrence
    Correspondence
    Corresponding author at: Nottingham University Hospitals NHS Trust, Room B02 Clinical Sciences Building, Hucknall Road, Nottingham NG5 1 PB, UK.
    Affiliations
    Nottingham University Hospitals NHS Trust, Clinical Sciences Building, Hucknall Road, Nottingham NG5 1 PB, UK

    Department of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies (UKCTAS), School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK
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  • A. Hunter
    Affiliations
    Department of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies (UKCTAS), School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK
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  • R. Murray
    Affiliations
    Department of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies (UKCTAS), School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK
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  • W.S. Lim
    Affiliations
    Nottingham University Hospitals NHS Trust, Clinical Sciences Building, Hucknall Road, Nottingham NG5 1 PB, UK

    Nottingham Biomedical Research Centre NIHR, UK
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  • T. McKeever
    Affiliations
    Department of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies (UKCTAS), School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK

    Nottingham Biomedical Research Centre NIHR, UK
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Published:August 26, 2019DOI:https://doi.org/10.1016/j.jinf.2019.08.014

      Highlights

      • Nine studies provided data for meta-analysis (n = 40,685 participants).
      • Current smokers were 5 times more likely to have laboratory-confirmed influenza than non-smokers.
      • Current smokers were 34% more likely to develop an influenza-like illness than non-smokers.

      Abstract

      Objectives

      The association of current smoking with influenza infection is not widely recognised. The aim of this systematic review was to summarise published evidence and quantify the risk of influenza infection in tobacco smokers compared to non-smokers.

      Methods

      We systematically searched MEDLINE, EMBASE, CINAHL, LILACS and Web of Science, from inception to 7 November 2017, to identify relevant randomised control trials, cohort and case-control studies. Study quality was assessed using the Newcastle–Ottawa Scale. We included studies defining influenza as a clinical syndrome and those using confirmatory microbiological tests. Pooled odds ratios (ORs) were estimated by using random effects model.

      Results

      The mean quality score across the nine included studies (n = 40,685 participants) was 5.4 of 9 (SD 1.07). Current smokers were over 5 times more likely to develop laboratory-confirmed influenza than non-smokers (pooled OR 5.69 (95% CI 2.79–11.60), 3 studies). For studies reporting the occurrence of an influenza-like illness (ILI), current smokers were 34% more likely to develop ILI than non-smokers (pooled OR 1.34 (95% CI 1.13–1.59), 6 studies).

      Conclusion

      Current smokers have an increased risk of developing influenza compared to non-smokers. The association was strongest in studies examining cases with laboratory confirmed influenza.

      Keywords

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