# The Correlation Between Smoking and Severity of COVID-19 Infection in Tribal Populations: A Single-Center Retrospective Cross-Sectional Study

## TL;DR

This study found that smoking is linked to more severe COVID-19 outcomes in tribal populations of North Maharashtra, India.

## Contribution

The study provides new evidence on the impact of smoking on COVID-19 severity specifically in Indian tribal communities.

## Key findings

- Daily cigarette consumption was significantly associated with higher CT severity scores.
- Longer smoking duration was linked to increased ventilator requirement and breathlessness.
- No significant association was found between smoking and oxygen requirement.

## Abstract

Background

Cigarette smoking is a well-established risk factor for respiratory diseases and has been proposed to worsen outcomes in COVID-19 infection. Limited evidence exists regarding this association among tribal populations in India, who often face socioeconomic and healthcare disparities. This study aimed to assess the correlation between cigarette smoking and the severity of COVID-19 infection among the tribal population of North Maharashtra.

Methods

A retrospective cross-sectional study was conducted among 75 patients with a confirmed history of COVID-19 infection in the tribal areas of Dhule District, Maharashtra, during July 2021. Data were collected through retrospective review of outpatient and inpatient medical records. Demographic details, smoking status, duration and intensity of smoking, comorbidities, and COVID-19 severity indicators were recorded. Associations between smoking variables and disease severity parameters, including CT severity score, ventilator requirement, breathlessness, and oxygen requirement, were analyzed using the Chi-square (χ²) test. A p-value <0.05 was considered statistically significant.

Results

Of the total (75) participants, 43 (57.3%) were smokers and 32 (42.7%) were non-smokers. A significant positive association was observed between daily cigarette consumption and CT severity score (χ²=50.406, p<0.001), and between duration of smoking and ventilator requirement (χ²=14.540, p=0.006). Longer smoking duration was also significantly associated with breathlessness as a presenting complaint (χ²=11.223, p=0.024). No statistically significant association was found between smoking status and oxygen requirement (p=0.077).

Conclusion

The findings indicate that cigarette smoking is significantly associated with increased disease severity and respiratory complications in COVID-19 among tribal populations. Individuals with a longer smoking history demonstrated higher CT severity scores and a greater need for ventilatory support. These results underscore the importance of targeted smoking cessation and respiratory health initiatives within vulnerable tribal communities to mitigate future pandemic-related risks.