Aims This study estimated annual healthcare expenditures attributable to current e-cigarette use among US adults, including current exclusive and dual/poly e-cigarette use.
Methods Analysing the 2015–2018 National Health Interview Survey data, we estimated the impacts of e-cigarette use on healthcare utilisation among adults aged 18+ years. Healthcare utilisation outcomes were hospital nights, emergency room (ER) visits, doctor visits and home visits. Current e-cigarette use was categorised as exclusive and dual/poly e-cigarette use. The econometric model included two equations: health status as a function of e-cigarette use and other independent variables, and healthcare utilisation as a function of health status, e-cigarette use, and other independent variables. Using an ‘excess utilisation’ approach, we multiplied the e-cigarette-attributable fraction derived from the model by annual health expenditures to calculate healthcare expenditures attributable to current exclusive and dual/poly e-cigarette use, the sum of which were expenditures attributable to all current e-cigarette use.
Results Current exclusive and dual/poly e-cigarette use, with 0.2% and 3.5% prevalence in 2015–2018, were associated with higher odds of reporting poor health status than never tobacco users. Poor health status was associated with higher odds of using the four healthcare services and a greater number of ER and doctor visits. Annual healthcare expenditures attributable to all current e-cigarette use was $15.1 billion ($2024 per user) in 2018, including $1.3 billion attributable to exclusive e-cigarette use ($1796 per user) and $13.8 billion attributable to dual/poly e-cigarette use ($2050 per user).
Conclusion Adult current e-cigarette use was associated with substantial excess healthcare utilisation and expenditures.
- electronic nicotine delivery devices
- public policy
Data availability statement
Not applicable. We used secondary data that are publicly available for our analysis.
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Contributors WBM is Principal Investigator. YW, H-Y S, JL, and WBM designed the methodology. YW conducted literature review and the statistical analysis. YW wrote the original draft of the manuscript. YW, H-Y S, JL, TY, and WBM reviewed, edited, and revised the manuscript. YW and WBM are responsible for the overall content.
Funding This study was funded by National Heart, Lung, and Blood Institute and the Food and Drug Administration (FDA) Center for Tobacco Products (Grant number: U54 HL147127).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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