Friday, December 2, 2022

Deficient and Unreliable Studies of Vaping and Disease


At least a dozen medical studies over the past few years have found that vaping is associated with heart attack, stroke, hypertension, emphysema and other lung disease, as well as diabetes (see the list at the end of this entry).  The studies are cross-sectional; they are drawn from population samples at one point in time.  They only produce associations, but those are then inflated to imply or outright claim that vaping causes those disease conditions.  The studies appeared in respected medical journals and, together, form a powerful disincentive for smokers to switch to vaping.  They also add fuel to the regulatory fire to suppress vape products, which are actually vastly safer than cigarettes. 

My research group has published a new analysis entitled, “Cross‑sectional e‑cigarette studies are unreliable without timing of exposure and disease diagnosis,” in the journal Internal and Emergency Medicine.

Our analysis shows that the dozen are irrevocably deficient and unreliable.  Some used data from National Health Interview Surveys (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), or the FDA’s Population Assessment of Tobacco and Health (PATH) surveys, all of which profile participants who smoked and/or vaped and who had ever been diagnosed with numerous diseases.  However, there is absolutely no information in the NHIS or BRFSS about when participants started to smoke or vape, or when they were first diagnosed with a disease. Absent this critical data, it is impossible to demonstrate that smoking or vaping preceded the disease, and therefore had any role in causing it.

While authors of some of the studies tried to use a statistical sleight of hand by claiming that their results were “adjusted” for smoking, that is not a legitimate work-around for the missing cause-and-effect information.

Some studies used PATH data, which does contain all of the information needed to analyze whether smoking and vaping preceded the diseases and therefore might have caused them.  Readers of my blog know that my research group in 2019 used PATH data to demonstrate that a heart attack study published in the flagship journal of the American Heart Association was pure fiction, resulting in its retraction by journal editors.  Now we have analyzed PATH data to demonstrate that none of the vaping-caused-disease claims in the recent studies are valid.

Our design was simple: We started by determining at what age participants were diagnosed with smoking-attributable diseases – chronic obstructive pulmonary disease (COPD), emphysema, myocardial infarction (MI, or heart attack) and stroke.  We then noted when participants started smoking or vaping.  The results were crystal clear.  As we reported in our study, “Only 4% of COPD and emphysema cases, 6% of MIs and 11% of stroke had occurred in PATH participants who had used e-cigarettes prior to the diagnoses. In contrast, over 94% of all cases occurred after smoking cigarettes fairly regularly.” 

In summary, the cited studies’ claims that vaping is related to or causes airway and circulatory diseases are not valid, as the authors lacked or ignored causative pathway information.  As for those few cases in which vaping preceded the disease, we note in our article, this may indicate “a potential reverse association between e-cigarette use and these diseases. In other words, having a diagnosis for respiratory and cardiovascular diseases leads smokers to use e-cigarettes.”


   Deficient and Unreliable Studies of Vaping and Disease

   Alzahrani T, Pena I, Temesgen N, Glantz SA (2018).  Association between electronic cigarette use and myocardial infarction.  Am J Prev Med 55(4):455-461.   

Vindhyal MR, Okut H, Ablah E, Ndunda PM, Kallail KJ, Choi WS (2020).  Cardiovascular outcomes associated with adult electronic cigarette use.  Cureus 12(8): e9618. 

Wills TA, Pagano I, Williams RJ, Tam EK (2019).  E-cigarette use and respiratory disorder in an adult sample.  Drug Alc Depend 194:363-370. 

Osei AD, Mirbolouk M, Orimoloye OA, et al (2019).  Association between e-cigarette use and cardiovascular disease among never and current combustible-cigarette smokers.  Am J Med 132:949-954. 

Parekh T, Pemmasani S, Desai R (2020).  Risk of stroke with e-cigarette and combustible cigarette use in young adults.  Am J Prev Med 58(3):446-452.

   Bircan E, Bezirhan U, Porter A, Fagan P, Orloff MS (2021).  Electronic cigarette use and its association with asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome among never cigarette smokers.  Tob Ind Dis 19:23. 

   Wills TA, Choi K, Pokhrel P, Pagano I (2022).  Tests for confounding with cigarette smoking in the association of e-cigarette use with respiratory disorder: 2020 national-sample data. Prev Med

Perez MF, Atuegwu N, Mead E, Oncken C, Mortensen EM (2018).  E-cigarette use is associated with emphysema, chronic bronchitis and COPD.  Am J Respir Crit Care Med 197:A6245.  

Zhang Z, Jiao Z, Blaha MJ, et al (2022).  The association between e-cigarette use and prediabetes: results from the Behavioral Risk Factor Surveillance System, 2016-2018.  Am J Prev Med 62(6):872-877. 

Atuegwu NC, Perez MF, Oncken C, Mead EL, Maheshwari N, Mortensen EM (2019).  E-cigarette use is associated with a self-reported diagnosis of prediabetes in never cigarette smokers: results from the Behavioral Risk Factor Surveillance System Survey.  Drug Alc Depend 205: 107692. doi:10.1016/j.drugalcdep.2019.10769

Miller CR, Shi H, Li D, Goniewicz ML (2021).  Cross-sectional associations of smoking and e-cigarette use with self-reported diagnosed hypertension: findings from Wave 3 of the Population Assessment of Tobacco and Health Study.  Toxics 9:52 

Osei AD, Mirbolouk M, Orimoloye OA et al. Association between e-cigarette use and chronic obstructive pulmonary disease by smoking status: Behavioral Risk Factor Surveillance System 2016 and 2017.  Am J Prev Med 58, ISSUE 3, P336-342, March 01, 2020.  

Osei AD, Mirbolouk M, Orimoloye, OA et al. The association between e-cigarette use and asthma among never combustible cigarette smokers: Behavioral Risk Factor Surveillance System (BRFSS) 2016 & 2017. BMC Pulm Med 19, 180 (2019).

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