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Vaping and Health Service Utilization: A Canadian Health Survey and Health Administrative Data Study.
Annals of the American Thoracic Society 2023 March 16
RATIONALE: Emerging research suggests that e-cigarette (EC) use may have detrimental health effects, increasing the burden on healthcare systems.
OBJECTIVES: This study aims to determine whether young EC users had increased asthma, asthma attacks, and health services use (HSU).
METHODS: This cohort study used the linked Canadian Community Health Survey (CCHS, cycles 2015-16 and 2017-18) and health administrative data (January 2015-March 2018). A propensity score method matched self-reported EC users to up to five controls. Matched multivariable logistic and negative binomial regressions were used to calculate odds ratios (OR), rate ratios (RR), and 95% confidence intervals (CI) with EC use as the exposure and asthma, asthma attacks, all-cause HSU as the outcomes, respectively.
RESULTS: Analyses included 2,700 matched CCHS participants (15-30 years), 505 (2.4% of 20,725 participants) EC users matched to 2,195 non-users. After adjusting for confounders, EC users with asthma had over two-fold higher odds of having an asthma attack in the last 12 months (OR=2.30; 95%CI:1.29-4.12). Dual EC and conventional tobacco users had a two-fold increased all-cause HSU rate compared to non-users who never smoked tobacco (RR=2.13; 95%CI:1.53-2.98). This rate was greater than EC users who never smoked tobacco (RR=1.73; 95% CI: 1.00-3.00) and non-EC users who regularly smoke tobacco (RR= 1.72; 95% CI: 1.29-2.29). Compared to male non-users, female EC users had the highest increased all-cause HSU (RR=1.94; 95% CI: 1.39-2.69) over male EC users and female non-users (RR=1.13; 95% CI: 0.86-1.48, RR= 1.41; 95% CI: 1.16-1.71, respectively).
CONCLUSION: Current EC use is associated with significantly increased odds of having had an asthma attack. Furthermore, concurrent EC use and conventional cigarette smoking are associated with a higher rate of all-cause HSU. The odds of asthma attack and all-cause HSU were highest among women. Thus, EC use may be an epidemiological biomarker for youth and young adults with increased health morbidity.
OBJECTIVES: This study aims to determine whether young EC users had increased asthma, asthma attacks, and health services use (HSU).
METHODS: This cohort study used the linked Canadian Community Health Survey (CCHS, cycles 2015-16 and 2017-18) and health administrative data (January 2015-March 2018). A propensity score method matched self-reported EC users to up to five controls. Matched multivariable logistic and negative binomial regressions were used to calculate odds ratios (OR), rate ratios (RR), and 95% confidence intervals (CI) with EC use as the exposure and asthma, asthma attacks, all-cause HSU as the outcomes, respectively.
RESULTS: Analyses included 2,700 matched CCHS participants (15-30 years), 505 (2.4% of 20,725 participants) EC users matched to 2,195 non-users. After adjusting for confounders, EC users with asthma had over two-fold higher odds of having an asthma attack in the last 12 months (OR=2.30; 95%CI:1.29-4.12). Dual EC and conventional tobacco users had a two-fold increased all-cause HSU rate compared to non-users who never smoked tobacco (RR=2.13; 95%CI:1.53-2.98). This rate was greater than EC users who never smoked tobacco (RR=1.73; 95% CI: 1.00-3.00) and non-EC users who regularly smoke tobacco (RR= 1.72; 95% CI: 1.29-2.29). Compared to male non-users, female EC users had the highest increased all-cause HSU (RR=1.94; 95% CI: 1.39-2.69) over male EC users and female non-users (RR=1.13; 95% CI: 0.86-1.48, RR= 1.41; 95% CI: 1.16-1.71, respectively).
CONCLUSION: Current EC use is associated with significantly increased odds of having had an asthma attack. Furthermore, concurrent EC use and conventional cigarette smoking are associated with a higher rate of all-cause HSU. The odds of asthma attack and all-cause HSU were highest among women. Thus, EC use may be an epidemiological biomarker for youth and young adults with increased health morbidity.
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