Why are 1 in 3 young adults at risk of severe COVID-19? One habit might be to blame
New research says that one in three young adults aged 18 to 25 are “medically vulnerable to severe COVID-19” largely because of their smoking habits rather than underlying health conditions. The research also has surprising results on the coronavirus and race.
The findings, published Monday in the Journal of Adolescent Health, come at a time when young people are making up large portions of new coronavirus cases across the country.
“Recent evidence indicates that smoking is associated with a higher likelihood of COVID-19 progression, including increased illness severity, ICU admission or death,” study lead author Dr. Sally Adams, a specialist in the University of California, San Francisco Division of Adolescent and Young Adult Medicine, said in a university news release. “Smoking may have significant effects in young adults, who typically have low rates for most chronic diseases.”
The U.S. Centers for Disease Control and Prevention says people over 65 years old and those with underlying medical conditions such as heart disease, obesity, kidney disease and diabetes are at increased risk for severe COVID-19, the disease the coronavirus causes.
Meanwhile, the agency lists smoking, as well as pregnancy and hypertension, as factors that “might” make an individual’s chances of severe coronavirus illness higher; but the study paints a different picture.
About 32% of young adults vulnerable to severe COVID-19
The UCSF researchers studied the most recent data from the National Health Interview Survey of 8,405 men and women between the ages of 18 and 25, according to the paper. The data was collected between 2016 and 2018.
Overall, one in three, or about 32%, of young adults are “medically vulnerable” to severe COVID-19, the study showed.
But, when you remove the people who reported smoking in the past 30 days from the mix, the percentage of risk drops to 16% — or about one in six young nonsmoking adults, the study showed.
At the same time, few of the participants reported that they had medical conditions the CDC considers risky during the coronavirus pandemic, the study said.
“The risk of being medically vulnerable to severe disease is halved when smokers are removed from the sample,” senior author Dr. Charles Irwin Jr., of the UCSF Division of Adolescent and Young Adult Medicine, said in the university news release. “Efforts to reduce smoking and e-cigarette use among young adults would likely lower their vulnerability to severe disease.”
Coronavirus and race, gender
What shocked the researchers the most was their findings on race and ethnicity, which contradicts previous research and trends since the pandemic began that shows racial and ethnic minorities are at greater risk of a severe coronavirus infection.
White people showed “higher vulnerability” to severe COVID-19 when compared with Black, Hispanic and Asian subgroups, according to the researchers, who note that whites have higher rates of smoking and e-cigarette use than minorities.
“Our finding of lower medical vulnerability of racial/ethnic minorities compared with the white subgroup, despite controlling for income and insurance status, was unexpected,” the researchers said in the study. “This suggests that factors other than the CDC’s medical vulnerability criteria play a role in the risk of severe COVID-19 illness in the young adult population.”
The study also showed that men are generally at higher risk of severe COVID-19 illness than women, likely because significantly fewer women smoked, “which resulted in overall medical vulnerability of 29.7% compared with 33.3% for young men,” according to the news release.
But young women were more likely to have asthma, immune conditions and be obese, the study said.
“However, the lack of information about prevalence, hospitalization, and deaths for young adults aged 18–25 years limits our ability to determine whether the conditions within the overall CDC vulnerability measure are the appropriate conditions to consider,” the researchers said in the study.
As well, not only is the NHIS survey data about 1.5 years old, but it also does not include incarcerated individuals who are “disproportionately members of minority groups.”
“To further our understanding of the impact of COVID-19 on young adults, these findings need to be compared with other indicators related to severe COVID-19 illness, such as hospitalization rates and mortality,” the researchers said. “Reporting on these indicators for the young adult age group would help inform a public health response that takes this unique age group into account.”
This story was originally published July 14, 2020 at 12:30 PM with the headline "Why are 1 in 3 young adults at risk of severe COVID-19? One habit might be to blame."
