ORIGINAL RESEARCH
Niharika Khanna, MD, MBBS, DGO; Carissa S. Kwan, MPH; Elena N. Klyushnenkova, PhD; Colleen Kernan, MPH; Michael Dark, DrPH; Julia Melamed, MSN; Janaki Deepak, MBBS
Corresponding Author: Niharika Khanna, MD, MBBS, DGO; University of Maryland School of Medicine.
Email: nkhanna@som.umaryland.edu
DOI: 10.3122/jabfm.2025.250265R1
Keywords: Electronic Nicotine Delivery Systems, Electronic Medical Records, Health Care Use, Hospitals, Logistic Regression, Respiratory Diseases, Smoking, Substance Use Disorders, Tobacco
Dates: Submitted: 07-11-2025; Revised: 10-14-2025; Accepted: 11-10-2025
Status: In Press.
INTRODUCTION: Electronic nicotine delivery systems (ENDS) use 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.
METHODS: 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.
RESULTS: Among ENDS only users, Non-Hispanic White and Other race patients had statistically significantly increased health care utilization compared to never users. 18-44 year-old patients in these two race groups had 1.9-2.3 times higher odds of utilizing the ED use compared to those who never used tobacco, while 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 health care utilization among those who used both ENDS and other tobacco ranged from 1.4-2.4 and also varied by age and race.
CONCLUSIONS: ENDS and tobacco use was associated with increased hospital utilization, including ED and inpatient, due to respiratory illnesses in an age and race dependent manner.