Association between e-cigarette use and COVID-19 diagnosis: a systematic review and meta-analysis

doi:10.1186/s12889-025-23618-y

. 2025 Aug 14;25(1):2764.

doi: 10.1186/s12889-025-23618-y.

Association between e-cigarette use and COVID-19 diagnosis: a systematic review and meta-analysis

Ying Xie^{1

2

3}, Xinmei Zhou^{2

3}, Dengmin Huang¹, Han Yao¹, Zheng Su^{2

3}, Zhao Liu^{2

3}, Anqi Cheng^{2

3}, Zhenxiao Huang^{1

2

3}, Jinxuan Li^{2

3

4}, Rui Qin^{2

3}, Yi Liu^{2

3

5}, Xin Xia^{2

3

5}, Qingqing Song^{2

3

4}, Liang Zhao^{2

3}, Dan Xiao^{6

7}, Chen Wang^{8

9

10}

Affiliations

¹ School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
² National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China.
³ WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China.
⁴ Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China.
⁵ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
⁶ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China. danxiao@263.net.
⁷ WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China. danxiao@263.net.
⁸ School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. wangchen@pumc.edu.cn.
⁹ WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China. wangchen@pumc.edu.cn.
¹⁰ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, Friendship Hospital, Beijing, China. wangchen@pumc.edu.cn.

PMID: 40814093
PMCID: PMC12351969
DOI: 10.1186/s12889-025-23618-y

Association between e-cigarette use and COVID-19 diagnosis: a systematic review and meta-analysis

Ying Xie et al. BMC Public Health. 2025.

. 2025 Aug 14;25(1):2764.

doi: 10.1186/s12889-025-23618-y.

Authors

Affiliations

¹ School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
² National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China.
³ WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China.
⁴ Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China.
⁵ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
⁶ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China. danxiao@263.net.
⁷ WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China. danxiao@263.net.
⁸ School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. wangchen@pumc.edu.cn.
⁹ WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, China. wangchen@pumc.edu.cn.
¹⁰ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, Friendship Hospital, Beijing, China. wangchen@pumc.edu.cn.

PMID: 40814093
PMCID: PMC12351969
DOI: 10.1186/s12889-025-23618-y

Abstract

Background: The impact of e-cigarettes on COVID-19 remains unclear. This study aims to assess the relationship between e-cigarette use and COVID-19 diagnosis and other related outcomes.

Methods: This systematic review and meta-analysis searched studies from 2019 to April 2nd, 2024, in Medline (via OVID), EMBASE, Scopus and the Cochrane Central Register of Controlled Trials for eligible observational studies.

Results: Among the initially identified 1116 items, a total of 20 studies met the inclusion criteria. The meta-analysis revealed that e-cigarette use was significantly associated with higher odds of COVID-19 diagnosis (N = 14, adjusted odds ratio, OR 1.25, 95% confidence interval, CI 1.07 to 1.47, I2 = 62%). This association was more pronounced among the youth (N = 4, adjusted OR 1.78, 95% CI 1.17 to 2.72, I2 = 75%) and current e-cigarette users (N = 14, adjusted OR 1.30, 95% CI 1.10 to 1.55, I2 = 55%). Though the association was not significant among cohort or case-control studies at first, the robust results were shown excluding low-quality studies (N = 3, adjusted OR 1.25, 95% CI 1.03 to 1.50, I2 = 0%). The results remained consistent in leave-one-out analyses. Drawing from the available but limited research, no significance was observed between e-cigarette use or other COVID-19 outcomes including severe COVID-19, COVID-19-related death, symptoms or hospital admission. Heterogeneity and risk of bias should be noticed when explaining our results.

Conclusions: E-cigarette use was associated with an increased risk of COVID-19 diagnosis, particularly among youth and current users. Further high-quality evidence is needed to assess the overall health effects of e-cigarettes, with a particular focus on the youth and current users.

Keywords: COVID-19; E-cigarettes; Meta-analysis; Tobacco.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Flow diagram of study identification and screening

**Fig. 2**
Association between e-cigarette use and COVID-19 diagnosis. Abbreviations: OR, odds ratio; CI, confidence interval

**Fig. 3**
Association between e-cigarette use and COVID-19 diagnosis stratified by different age groups with adjusted odds ratios. Abbreviations: OR, odds ratio; CI, confidence interval

**Fig. 4**
Association between e-cigarette use and COVID-19 diagnosis stratified by different e-cigarette use patterns with adjusted odds ratios. Abbreviations: OR, odds ratio; CI, confidence interval

See this image and copyright information in PMC

References

1. Le Foll B, Piper ME, Fowler CD, et al. Tobacco and nicotine use. Nat Rev Dis Primers. 2022;8(1):19. 10.1038/s41572-022-00346-w. - PubMed
1. Chaumont M, Bernard A, Pochet S, et al. High-Wattage E-Cigarettes induce tissue hypoxia and lower airway injury: A randomized clinical trial. Am J Respir Crit Care Med. 2018;198(1):123–6. 10.1164/rccm.201711-2198LE. - PubMed
1. Ci V, Gn NAMKVE, Pk C. Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide. Chest. 2012;141(6). 10.1378/chest.11-2443. - PubMed
1. Health CO. on S and. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. 2021. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-d.... Accessed 26 June 2023.
1. Chaffee BW, Barrington-Trimis J, Liu F, et al. E-cigarette use and adverse respiratory symptoms among adolescents and young adults in the united States. Prev Med. 2021;153:106766. 10.1016/j.ypmed.2021.106766. - PMC - PubMed

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[1] Le Foll B, Piper ME, Fowler CD, et al. Tobacco and nicotine use. Nat Rev Dis Primers. 2022;8(1):19. 10.1038/s41572-022-00346-w. - PubMed

[2] Le Foll B, Piper ME, Fowler CD, et al. Tobacco and nicotine use. Nat Rev Dis Primers. 2022;8(1):19. 10.1038/s41572-022-00346-w. - PubMed

[3] Chaumont M, Bernard A, Pochet S, et al. High-Wattage E-Cigarettes induce tissue hypoxia and lower airway injury: A randomized clinical trial. Am J Respir Crit Care Med. 2018;198(1):123–6. 10.1164/rccm.201711-2198LE. - PubMed

[4] Chaumont M, Bernard A, Pochet S, et al. High-Wattage E-Cigarettes induce tissue hypoxia and lower airway injury: A randomized clinical trial. Am J Respir Crit Care Med. 2018;198(1):123–6. 10.1164/rccm.201711-2198LE. - PubMed

[5] Ci V, Gn NAMKVE, Pk C. Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide. Chest. 2012;141(6). 10.1378/chest.11-2443. - PubMed

[6] Ci V, Gn NAMKVE, Pk C. Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide. Chest. 2012;141(6). 10.1378/chest.11-2443. - PubMed

[7] Health CO. on S and. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. 2021. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-d.... Accessed 26 June 2023.

[8] Health CO. on S and. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. 2021. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-d.... Accessed 26 June 2023.

[9] Chaffee BW, Barrington-Trimis J, Liu F, et al. E-cigarette use and adverse respiratory symptoms among adolescents and young adults in the united States. Prev Med. 2021;153:106766. 10.1016/j.ypmed.2021.106766. - PMC - PubMed

[10] Chaffee BW, Barrington-Trimis J, Liu F, et al. E-cigarette use and adverse respiratory symptoms among adolescents and young adults in the united States. Prev Med. 2021;153:106766. 10.1016/j.ypmed.2021.106766. - PMC - PubMed

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Association between e-cigarette use and COVID-19 diagnosis: a systematic review and meta-analysis

Affiliations

Association between e-cigarette use and COVID-19 diagnosis: a systematic review and meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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