Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis

Baskaran, Vadsala; Murray, Rachael L.; Hunter, Abby; Lim, Wei Shen; McKeever, Tricia M.

Abstract

Aim
To summarise and quantify the effect of tobacco smoking on the risk of developing community acquired pneumonia (CAP) in adults.

Methods
We systematically searched MEDLINE, Embase, CINAHL, PsychINFO and Web of Science, from inception to October 2017, to identify case-control and cohort studies and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The review protocol was registered with the PROSPERO database (CRD42018093943). Study quality was assessed by the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) or hazard ratios (HRs) were estimated using a random-effects model.

Results
Of 647 studies identified, 27 studies were included (n = 460,592 participants) in the systematic review. Most of the included studies were of moderate quality with a median score of six (IQR 6–7). Meta-analysis showed that current smokers (pooled OR 2.17, 95% CI 1.70–2.76, n = 13 studies; pooled HR 1.52, 95% CI 1.13–2.04, n = 7 studies) and ex-smokers (pooled OR 1.49, 95% CI 1.26–1.75, n = 8 studies; pooled HR 1.18, 95% CI 0.91–1.52, n = 6 studies) were more likely to develop CAP compared to never smokers. Although the association between passive smoking and risk of CAP in adults of all ages was not statistically significant (pooled OR 1.13, 95% CI 0.94–1.36, n = 5 studies), passive smoking in adults aged ≥65 years was associated with a 64% increased risk of CAP (pooled OR 1.64; 95% CI 1.17–2.30, n = 2 studies). Dose-response analyses of data from five studies revealed a significant trend; current smokers who smoked higher amount of tobacco had a higher risk of CAP.

Conclusion
Tobacco smoke exposure is significantly associated with the development of CAP in current smokers and ex-smokers. Adults aged > 65 years who are passive smokers are also at higher risk of CAP. For current smokers, a significant dose-response relationship is evident.

Citation

Baskaran, V., Murray, R. L., Hunter, A., Lim, W. S., & McKeever, T. M. (2019). Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis. PLoS ONE, 14(7), Article e0220204. https://doi.org/10.1371/journal.pone.0220204

• Journal Article Type: Article
• Acceptance Date: Jul 10, 2019
• Online Publication Date: Jul 18, 2019
• Publication Date: Jul 18, 2019
• Deposit Date: Jul 22, 2019
• Publicly Available Date: Jul 23, 2019
• Journal: PLOS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 7
• Article Number: e0220204
• DOI: https://doi.org/10.1371/journal.pone.0220204
• Keywords: General biochemistry, Genetics and molecular biology; General agricultural and biological sciences; General medicine
• Public URL: https://nottingham-repository.worktribe.com/output/2329459
• Publisher URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220204