Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes

Area of Science:

• Public Health
• Epidemiology
• Toxicology

Background:

• E-cigarettes are marketed as a less harmful alternative to traditional cigarettes.
• Direct comparisons of health effects between e-cigarettes, dual use, and traditional cigarettes are lacking in the general population.

Approach:

• A systematic review and random-effects meta-analysis of studies published up to October 1, 2023, from major databases (PubMed, EMBASE, Web of Science, PsychINFO).
• Assessed risk of bias using ROBINS-I and certainty of evidence with GRADE.
• Pooled data for disease outcomes with at least five studies; summarized outcomes with fewer studies.

Key Points:

• Current e-cigarette use was not associated with increased risk for cardiovascular disease, stroke, or metabolic dysfunction compared to cigarette use.
• E-cigarette use was associated with lower odds of asthma, COPD, and oral disease compared to cigarette use.
• Dual use (e-cigarettes and cigarettes) significantly increased the odds of all studied health outcomes compared to exclusive cigarette use.

Conclusions:

• The assumption of substantial harm reduction from e-cigarettes across all cigarette-related diseases needs reassessment.
• Dual use presents a significant public health concern, increasing disease risks beyond those of exclusive cigarette use.
• Further research is needed on the long-term health effects of e-cigarette use and dual use.