COVID-19 incidence and death correlated with vaping across states

There is a robust literature showing that e-cigarette use damages lung function and compromises immune function in the respiratory system, which makes it reasonable to expect that e-cigarette use would be associated with more COVID-19 infections and deaths. So far, there has been one study (in youth and young adults) showing increased risk of developing COVID-19 among people who people who used e-cigarettes.

Now Dongmei Li and colleagues have presented national data showing that states in with higher e-cigarette use had more COVID-19 cases and deaths. In their paper, “The association between statewide vaping prevalence and COVID-19,” they found that, after controlling for smoking and several other risk factors, states with higher e-cigarette use in 2018 had more COVID-19 in 2020.

As the authors note, this ecological study is not as strong evidence as an epidemiological study that links e-cigarette use to COVID-19 at the individual level, but it does represent an important contribution to the growing case that vaping is a lot more dangerous than the tobacco companies and e-cigarette optimists have thought. Surprisingly while the authors found a statistically significant effect of e-cigarette use with COVID-91, the association with smoking was not statistically significant. In particular, it adds to the evidence that avoiding e-cigarettes would be a prudent step to reduce COVID-19 risk.

Here is the abstract from the paper:

Existing literature indicated electronic cigarette users (vapers) have impaired immune response that might increase vulnerability to coronavirus disease 2019 (COVID-19) infection and death. However, whether vapers are more susceptible to COVID-19 is unknown. Using integrated data in each US state from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), United States Census Bureau and the website, generalized estimating equation (GEE) models with negative binomial distribution assumption and log link functions were used to examine the association of statewide e-cigarette use prevalence with number of COVID-19 cases and deaths in the US on a state level from January 21, 2020 to April 25, 2020. The weighted proportion of vapers who used e-cigarettes every day or some days ranged from 2.86% to 6.42% for US states. Statistically significant associations were observed between the weighted proportion of vapers and number of COVID-19 cases as well as COVID-19 deaths in the US after adjusting for the weighted proportion of smokers and other significant covariates in the GEE models. With every one percent increase in weighted proportion of vapers in each state, the number of COVID-19 cases increase by 0.3139 (95% CI: 0.0554-0.5723) and the number of COVID-19 deaths increase by 0.3730 (95% CI: 0.0815-0.6646) in log scale in each US state. The positive associations between the proportion of vapers and the number of COVID-19 cases and deaths in each US state in this ecological study suggest an increased susceptibility of vapers to COVID-19 on a state level and warrants further investigation.

The full citation is Li D, Croft DP, Ossip DJ, Xie Z. The association between statewide vaping prevalence and COVID-19. Prev Med Rep. 2020 Dec;20:101254. doi: 10.1016/j.pmedr.2020.101254. Epub 2020 Nov 25. PMID: 33257909; PMCID: PMC7687362. It is available for free here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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