Association of Electronic Cigarette Use With Incident Respiratory Conditions Among US Adults From 2013 to 2018

Abstract

Importance: Generating robust and timely evidence about the respiratory health risks of electronic cigarettes (e-cigarettes) is critical for informing state and federal regulatory standards for product safety.

Objective: To examine the association of e-cigarette use with incident respiratory conditions, including chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, and asthma.

Design, setting, and participants: This prospective cohort study used data from the nationally representative cohort of US adults from the Population Assessment of Tobacco and Health (PATH) study, including wave 1 from 2013 to 2014, wave 2 from 2014 to 2015, wave 3 from 2015 to 2016, and wave 4 from 2016 to 2018. Individuals aged 18 years and older at baseline with no prevalent respiratory conditions were included in the analyses. Analyses were conducted from February to July 2020.

Exposures: e-Cigarette use was assessed by self-reported current use status (never, former, or current) at baseline.

Main outcomes and measures: Incident respiratory conditions, including COPD, emphysema, chronic bronchitis, and asthma, as well as a composite respiratory disease encompassing all 4 conditions.

Results: Among 21 618 respondents included in the analyses, 11 017 (491%) were men and 12 969 (65.2%) were non-Hispanic White. A total of 14 213 respondents were never e-cigarette users, 5076 respondents (11.6%) were former e-cigarette users, and 2329 respondents (5.2%) were current e-cigarette users. Adjusted for cigarette and other combustible tobacco product use, demographic characteristics, and chronic health conditions, there was an increased risk of respiratory disease among former e-cigarette uses (incidence rate ratio [IRR], 1.28; 95% CI, 1.09-1.50) and current e-cigarette users (IRR, 1.31; 95% CI, 1.08-1.59). Among respondents with good self-rated health, the IRR for former e-cigarette users was 1.21 (95%CI, 1.00-1.46) and the IRR for current e-cigarette users was 1.43 (95% CI, 1.14-1.79). For specific respiratory diseases among current e-cigarette users, the IRR was 1.33 (95% CI, 1.06-1.67) for chronic bronchitis, 1.69 (95% CI, 1.15-2.49) for emphysema, 1.57 (95% CI, 1.15-2.13) for COPD, and 1.31 (95% CI, 1.01-1.71) for asthma.

Conclusions and relevance: This cohort study found that e-cigarette use was associated with an increased risk of developing respiratory disease independent of cigarette smoking. These findings add important evidence on the risk profile of novel tobacco products.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Kathuria reported serving as the section editor for the tobacco dependence treatment section in UpToDate. Dr Blaha reported receiving grants from the Food and Drug Administration (FDA) during the conduct of the study; personal fees from Regeneron, Novartis, Novo Nordisk, Bayer, Akcea, 89Bio, Zogenix, Tricida, Gilead, and Amgen outside the submitted work. Dr Robertson reported receiving grants from the FDA and National Institutes of Health (NIH) during the conduct of the study. Dr Benjamin reported receiving grants from the NIH and American Heart Association during the conduct of the study. Dr Stokes reported receiving grants from Ethicon, a subsidiary of Johnson and Johnson, outside the submitted work. No other disclosures were reported.

Figures

Figure.. Associations of e-Cigarette Use With the Risk of Respiratory Diseasea

Healthy respondents 1 indicates individuals who had no self-reported chronic conditions, including any general health (ie, hypertension, high cholesterol, heart attack, heart failure, stroke, and diabetes) or respiratory-specific conditions (ie, chronic obstructive pulmonary disease, emphysema, chronic bronchitis, and asthma); healthy respondents 2, individuals whose self-rated overall physical health were good, great, or excellent; and IRR, incidence rate ratio. aIncludes chronic obstructive pulmonary disease, chronic bronchitis, emphysema, and asthma.