One in three young adults at risk for severe COVID-19
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Approximately one-third of adults aged 18 to 25 years are at risk for severe COVID-19, according to a study published in the Journals of Adolescent Health.
Smoking likely plays a large part in the risk for severe disease among young adults, according to the researchers.
“Recent evidence indicates that smoking is associated with a higher likelihood of COVID-19 progression, including increased illness severity, ICU admission or death,” Sally H. Adams, PhD, RN, a specialist in the division of adolescent and young adult medicine at the University of California, San Francisco, said in a press release. “Smoking may have significant effects in young adults, who typically have low rates for most chronic diseases.”
Adams and colleagues evaluated a subsample of adults aged 18 to 25 years who participated in the National Health Interview Survey. They used data from 2016 to 2018 in the nationally representative data set.
The researchers measured medical vulnerability among young adults using the CDC’s risk indicators for severe COVID-19. These included medical conditions — heart conditions, diabetes, asthma, immune condition, liver conditions and obesity — as well as smoking-related indicators such as past 30-day use of tobacco, electronic cigarettes and cigars or similar products.
Although e-cigarette use is not included on the CDC’s list of factors that confer vulnerability, the researchers included it in the study due to the adverse effects it has on respiratory and immune function as well as the National Institute on Drug Abuse’s suggestion that COVID-19 may pose a serious threat to people who smoke or vape.
Among the 8,405 young adults included in the sample, Adams and colleagues reported that 32% were medically vulnerable.
When examining the 6,741 nonsmokers from the overall sample, the researchers found that the medical vulnerability was 16%, nearly half the rate of the sample that included smokers.
Medical vulnerability was higher in males than females in the overall samples (33% vs. 30%). In the nonsmoking sample, however, females had higher medical vulnerability (19% vs. 14%). The researchers said that higher rates of asthma and immune conditions led to higher medical vulnerability in females.
In the overall sample, white young adults had higher rates of medical vulnerability (35%) compared with Black (31%), Asian (18%) and Hispanic (24%) young adults.
The researchers also found that medical vulnerability in the nonsmoking sample was higher in white young adults (17%), compared with Asian (10%) and Hispanic (13%) young adults. In this sample, the rate of medical vulnerability was higher in Black young adults (20%) compared with white young adults, but the researchers noted that this difference was not significant.
Adams and colleagues noted that their findings of lower medical vulnerability among Black, Asian and Hispanic young adults compared with white adults — despite having controlled for insurance status and income — were unexpected. They also explained that this was inconsistent with previous findings that showed higher rates of COVID-19 morbidity and mortality among Black and Hispanic people in the U.S.
Therefore, Adams and colleagues wrote that factors other than those listed in the CDC’s criteria for medical vulnerability may play a key role in determining risk for severe COVID-19, such as a social determinants of health framework to help identify other factors that contribute to disease severity.
“The risk of being medically vulnerable to severe disease is halved when smokers are removed from the sample,” Charles Irwin Jr, MD, professor of pediatrics in the division of adolescent and young adult medicine at the University of California, San Francisco, said in the release. “Efforts to reduce smoking and e-cigarette use among young adults would likely lower their vulnerability to severe disease.”
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