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Meta-Analysis
. 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 Huang  1 , Han Yao  1 , 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
Meta-Analysis

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

Ying Xie et al. BMC Public Health. .

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
Fig. 1
Flow diagram of study identification and screening
Fig. 2
Fig. 2
Association between e-cigarette use and COVID-19 diagnosis. Abbreviations: OR, odds ratio; CI, confidence interval
Fig. 3
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
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

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