Comparison of e-Cigarette and Cigarette Use and Dual Use Associations With Disease: Updated Systematic Review and...

Area of Science:

• Public Health
• Toxicology
• Epidemiology

Background:

• Electronic cigarettes (e-cigarettes) are frequently promoted as a less harmful alternative to combustible cigarettes.
• Previous meta-analyses have explored the association between e-cigarette use and various disease risks.

Purpose of the Study:

• To update a previous meta-analysis by incorporating recent population studies on e-cigarette disease risks.
• To compare disease risks associated with e-cigarette use, combustible cigarette use, and dual use.

Main Methods:

• A random-effects meta-analysis was conducted, pooling data from studies published between January 1, 2005, and January 1, 2025.
• Data were sourced from major scientific databases: PubMed, EMBASE, Web of Science, and PsychINFO.
• A minimum of five studies per disease outcome was required for inclusion in the meta-analysis.

Main Results:

• E-cigarette use showed similar risks for metabolic and oral diseases compared to combustible cigarette use.
• E-cigarette use was associated with reduced odds for cardiovascular disease, stroke, asthma, COPD, and fetal growth compared to combustible cigarettes.
• Dual use (both e-cigarettes and combustible cigarettes) significantly increased the odds for most health outcomes compared to exclusive combustible cigarette use.
• Exclusive e-cigarette use was associated with increased odds for most outcomes compared to non-use, except for fetal growth.
• Studies generally had a low risk of bias, and results were robust across different study characteristics, though confidence was low for stroke and fetal growth outcomes.

Conclusions:

• The growing body of evidence indicates that e-cigarette use is associated with disease risks comparable to combustible cigarette use.
• Dual use of e-cigarettes and combustible cigarettes is linked to substantially higher disease risks.
• E-cigarettes should not be promoted as a safer alternative to combustible cigarettes due to the observed health risks.