Association of cigarette and electronic cigarette use patterns with all-cause mortality: A national cohort study of 145,390 US adults

While e-cigarette use is associated with adverse cardiopulmonary health effects, the mortality risks associated with e-cigarette use alone and combined with smoking remain unexamined. Data between 2014 and 2018 were obtained from the National Health Interview Survey (NHIS), an annual cross-sectional survey of US adults. All-cause mortality and date of death were obtained via linkage of the NHIS to the National Death Index through December 31, 2019. A 6-category composite cigarette (never, former, current) and e-cigarette (current, non-current) exposure variable was created. We examined the association of cigarette and e-cigarette use patterns with all-cause mortality using adjusted Cox models. Among 145,390 participants (79,294 women [51.5%]; 60,560 aged 18–44 [47.4%]), 5220 deaths were observed over a median follow-up of 3.5 years (508,545 total person-years). Dual use of cigarettes and e-cigarettes was associated with higher mortality risk compared with non-current e-cigarette use in combination with never smoking (hazard ratio [HR] 2.44; 95% CI, 1.90–3.13) and had a risk that did not differ from current exclusive smoking (HR, 1.06; 95% CI, 0.83–1.37). Current e-cigarette use in combination with former smoking was associated with a lower mortality risk than current exclusive cigarette smoking (HR 0.64; 95% CI, 0.41−0.99). The addition of e-cigarette use to smoking does not reduce mortality risk compared with exclusive smoking. However, transitioning completely from cigarettes to e-cigarettes may be associated with mortality risk reduction. Further research is needed to verify these findings in larger cohorts and over longer periods of follow-up. •Dual use of cigarettes and e-cigarettes is associated with high mortality risk.•The addition of e-cigarette use to smoking does not reduce mortality risk.•Cigarette to e-cigarette switching may be associated with decreased mortality risk.•Further research is needed to verify our findings over longer periods of follow-up.