Temporal Trends in Vaping Use: Demographic Diversity and Healthcare Utilization Outcomes

ABSTRACT BACKGROUND Use of electronic cigarettes (e-cigarettes) has increased substantially in recent years. Marketed as a safer alternative to conventional tobacco cigarettes, the safety profile of e-cigarettes is now being questioned. Importantly, the clinical consequences of e-cigarette use remain poorly characterized. METHODS Using data from the electronic health record (EHR), we identified a cohort of e-cigarette users and never-smokers in the region of central Los Angeles. Using information extracted from the EHR, we assessed temporal trends in the demographic characteristics of e-cigarette users, including race/ethnicity and location of residence. We also used data on urgent medical visits (i.e. emergency department encounters and hospital admissions) occurring during the study period (January 2014 to January 2020) and employed a negative binomial regression model to compare healthcare utilization rates between e-cigarette users and never-smokers. RESULTS We identified a total of 698 e-cigarette users, in addition to 999 never-smokers, with demographic, clinical, and outcomes data available over the duration of the study period. From the beginning to the end of the study period, e-cigarette use increased across all race/ethnicity groups and across all geographic regions of residence. Notably, e-cigarette users experienced a 4.96 higher rate of urgent medical visits when compared to never-smokers evaluated over the same study period. CONCLUSION E-cigarettes use continues to expand, with evidence of racial/ethnic as well as geographic variation in uptake. Use of e-cigarette devices is associated with substantially higher rates of urgent healthcare utilization. These findings highlight the need for a more granular understanding of e-cigarette use and enhanced attention to the diversity as well as breadth of the population affected by this burgeoning health crisis.