A58-21 Clinical Outcomes of Vaping Versus Cigarette Smoking in Adolescents and Young Adults Hospitalized With Acute Respiratory Failure: A National Case-Control Study

Rationale

The prevalence of electronic cigarette use has increased substantially over the past decade, particularly among adolescents and young adults due to its promotion as a safer alternative. Despite growing concern of E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI), inpatient studies directly comparing vaping-related illness with traditional cigarette smoking remain limited. In this study, we sought to compare mortality, in-hospital complications, and resource utilization among patients hospitalized with acute respiratory failure (ARF) contrasting vaping and cigarette smoking.

Methods

We conducted a retrospective case-control study using 2016-2022 data from the National Inpatient Sample (NIS). Patients aged 12 to 44 years hospitalized with ARF were included. Vaping-related disorder was identified using ICD-10-CM codes consistent with EVALI, and smoking-related disorder was selected using tobacco-related respiratory disease codes. Patients with dual exposure were excluded. Survey weighted multivariable regression assessed in-hospital mortality, complications, length of stay (LOS), and hospital charges, adjusting for patient and hospital characteristics. Models were adjusted for age, sex, race, religion, primary payer, hospital bed size, location, and teaching status.

Results

Out of the 250,485 hospitalizations for ARF, 247,815 were smoking-related and 2,670 were vaping-related admissions. Patients in the vaping group were younger (mean age 25.4 vs 35.0 years) and more likely to be adolescents aged 12 to 17 years than adults aged 18 to 44 years (14.4% vs 0.4%, p < 0.001). Vaping-related admissions were also more prevalent at urban teaching hospitals. After multivariable adjustment, vaping-related disorder was associated with significantly lower odds of in-hospital mortality (OR 0.41, 95% CI 0.19-0.87), cardiac arrest (OR 0.44, 95% CI 0.22-0.88), mechanical ventilation (OR 0.32, 95% CI 0.25-0.42), stroke (OR 0.31, 95% CI 0.10-0.97), and acute kidney injury (OR 0.56, 95% CI 0.43-0.74). There were no statistically significant differences in STEMI, coronary revascularization, or anoxic brain injury. In adjusted linear models, vaping was not independently associated with an increased LOS (0.03 days, p = 0.90) or total hospital charges (-$7,663, p = 0.30).

Conclusion

Among adolescents and young adults hospitalized with ARF, vaping-related disorder was associated with lower in-hospital mortality and fewer severe complications compared with smoking-related disorder. However, vaping remained associated with substantial acute morbidity and did not confer a reduction in LOS or costs. Consistent with prior reports of EVALI, these findings suggest that while vaping may carry a lower acute risk profile than cigarette smoking, it should not be considered benign. Further longitudinal studies are needed to evaluate long-term outcomes and cumulative risk in this population.

This abstract is funded by: None