Tobacco smoking and the risk of Long COVID: a prospective cohort study with mediation analysis - 15/10/25
, Isaac Olushola Ogunkola b, Nafisat Dasola Jimoh c, Najim Z Alshahrani d, Deborah Oluwaseun Shomuyiwa e, Aishat Jumoke Alaran f, Don Eliseo Lucero-Prisno g, h, i
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Highlights |
• | Smoking was not an independent predictor of Long COVID after adjusting for demographic and socioeconomic factors. |
• | The association between smoking and Long COVID appeared to be partly mediated through baseline long-standing illness or disability. |
• | Current smokers reported a higher proportion of fatigue, muscle aches, shortness of breath, coughing, and headaches than non-smokers, but none of these differences were statistically significant. |
• | Integrating smoking cessation with chronic disease management may help reduce Long COVID vulnerability and symptom severity in clinical practice. |
Abstract |
Background |
Tobacco smoking is a well-established risk factor for severe acute COVID-19 outcomes, but evidence regarding its role in Long COVID is limited and inconsistent. This study investigated whether pre-pandemic smoking independently predicted Long COVID and assessed mediation by long-standing illness or disability in a nationally representative cohort.
Methods |
We analysed data from Waves 10 (2018–19) and 14 (2022–23) of the UK Household Longitudinal Study. Smoking status (current vs non-smoker) and covariates (age, sex, education, income satisfaction, ethnicity, rural/urban residence) were measured at baseline (Wave 10). Long COVID, defined as symptoms lasting ≥12 weeks following initial COVID-19 infection, was assessed at follow-up (Wave 14). Logistic regression was used to estimate the total association between smoking and Long COVID. We then applied generalized structural equation modelling and parametric causal mediation analysis, specifying long-standing illness or disability at baseline as the mediator.
Results |
Among 11,944 participants, 1097 (9.2 %) reported Long COVID symptoms at follow-up. In the unadjusted model, smoking was associated with increased odds of Long COVID (odds ratio [OR] = 1.22, 95 % CI: 1.00–1.48, p = 0.05), although this was only borderline significant. After adjusting for demographic and socioeconomic factors, the association was no longer statistically significant (adjusted OR = 1.11, 95 % CI: 0.91–1.35, p = 0.32). The structural equation model indicated that smoking was associated with higher likelihood of long-standing illness or disability at baseline (β = 0.461, 95 % CI: 0.33–0.59, p <0.001, log-odds scale), which in turn predicted Long COVID (β = 0.435, 95 % CI: 0.30–0.57, p <0.001, log-odds scale). Mediation analysis revealed a small but statistically significant indirect effect of smoking on Long COVID operating through long-standing illness or disability (risk difference = 0.0057, 95 % CI: 0.0020–0.0095, p = 0.003), but no significant direct effect (risk difference = 0.0027, 95 % CI: –0.0144 to 0.0199, p = 0.76).
Conclusion |
Smoking did not independently predict Long COVID, but may increase vulnerability indirectly through pre-existing long-standing illness or disability.
Le texte complet de cet article est disponible en PDF.Keywords : Long COVID, Tobacco smoking, Chronic health conditions, Mediation analysis, COVID-19
Plan
Vol 73 - N° 5
Article 203142- octobre 2025 Retour au numéro
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