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Vaping and Health Service Utilization: A Canadian Health Survey and Health Administrative Data Study.

T. To,C. Borkhoff,C. Chow,T. Moraes,R. Schwartz,N. Vozoris,A. van Dam,Chris Langlois,Kimball Zhang,E. Terebessy,Jingqin Zhu

Published 2023 in Annals of the American Thoracic Society

ABSTRACT

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.

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