Electronic Cigarette Use Is Not Associated with COVID-19 Diagnosis

Area of Science:

• Pulmonology
• Infectious Diseases
• Public Health

Background:

• E-cigarette use is prevalent, and its association with SARS-CoV-2 infection risk is a critical public health question.
• Understanding the relationship between various forms of nicotine and tobacco product use and COVID-19 susceptibility is essential for informed public health guidance.

Purpose of the Study:

• To test the hypothesis that current e-cigarette use is associated with an increased risk of SARS-CoV-2 infection.
• To compare the risk of COVID-19 diagnosis among exclusive e-cigarette users, exclusive conventional cigarette smokers, and dual users.

Main Methods:

• A retrospective analysis of 69,264 patients aged 12+ years who sought medical care at Mayo Clinic between September 15, 2019, and November 30, 2020.
• E-cigarette and conventional cigarette use data were collected via an electronic health record tool.
• Logistic regression models were used to assess the association between e-cigarette use and COVID-19 diagnosis, controlling for relevant factors.

Main Results:

• Patients who used only e-cigarettes were not more likely to have a COVID-19 diagnosis (OR 0.93 [0.69-1.25], P=.628).
• Exclusive conventional cigarette smokers showed a decreased risk of COVID-19 diagnosis (OR 0.43 [0.35-0.53], P<.001).
• Dual users (e-cigarette and conventional cigarette) had an intermediate risk (OR 0.67 [0.49-0.92], P=.013).

Conclusions:

• Current e-cigarette use was not associated with an increased risk of SARS-CoV-2 infection in this patient cohort.
• The findings suggest that any potential beneficial effects of conventional cigarette smoking on SARS-CoV-2 susceptibility are not mediated by nicotine.
• E-cigarettes, despite their known harms, do not appear to increase susceptibility to SARS-CoV-2 infection.