Hospital Utilization Among Users of Electronic Nicotine Delivery Systems (ENDS) Compared to Other Tobacco Users.

Abstract

Use of electronic nicotine delivery systems (ENDS) poses a significant and avoidable risk to respiratory health, yet its effect is not fully understood. This study examines the levels of hospital utilization among those who use ENDS and/or other tobacco and develop respiratory conditions. 260,149 adult patients were screened for ENDS use between August 2020 and June 2022 at the University of Maryland Medical System. Multivariable nominal logistic regression modeling was used to assess associations between tobacco/nicotine use and emergency department (ED) or inpatient utilization due to respiratory conditions defined by admission or discharge ICD-10 J codes. Covariates included age, sex, race, Elixhauser comorbidity score, and history of COVID-19. Among ENDS-only users, non-Hispanic White and Other-race patients had statistically significant increased healthcare utilization compared to never users (those who never use ENDS or tobacco). 18-44 year-old patients in these two race groups had 1.9-2.3 times higher odds of utilizing the ED compared to those who never used tobacco; and 65+ year-old non-Hispanic White patients had 2.4 times higher odds of inpatient admission compared to patients who never used tobacco. The odds of increased healthcare utilization among those who used both ENDS and other tobacco ranged from 1.4-2.4 and also varied by age and race. ENDS and tobacco use were associated with increased hospital utilization, including ED and inpatient, due to respiratory illnesses in an age- and race-dependent manner.