The association between combustible/electronic cigarette use and stroke based on national health and nutrition examination survey

Abstract

Aims: This study aims to analyze the association between combustible/electronic cigarettes and the risk of stroke.

Methods: We obtained data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). The stroke history and combustible/electronic cigarette use were acquired by questionnaires. Considering the sole or dual use of combustible cigarettes and electronic cigarettes (e-cigarettes), we divided all the individuals into four subgroups, including nonsmokers (reference group), sole combustible cigarette, sole e-cigarette, and dual use of both combustible cigarettes and e-cigarettes. We performed multivariable logistic regression to determine the association between cigarette use with the prevalence of stroke. We used odds ratios (ORs) with 95% confidence intervals (CIs) to show the effect size. Finally, we developed a prediction model to evaluate the risk of stroke for individuals with combustible or electronic cigarette use based on a random forest model.

Results: We included a total of 4022 participants in the study. The median age was 55, and 48.3% of the participants were males. When we adjusted for age, gender, education attainment, race, total-to-HDL cholesterol (< 5.9 or ≥ 5.9), diabetes, hypertension, and alcohol consumption, the groups of sole e-cigarette use, sole combustible cigarette use, and dual use of combustible and electronic cigarettes were significantly associated with the prevalence of stroke with ORs (with 95%CI) of 2.07 (1.04-3.81), 2.36 (1.52-3.59), 2.34 (1.44-3.68), respectively. In the testing set, the AUC was 0.74 (95%CI = 0.65-0.84), sensitivity was 0.68, and specificity was 0.75.

Conclusion: Sole e-cigarettes and dual use of e-cigarettes with combustible cigarettes might increase the risk of stroke.

Keywords: Clinical prediction model.; Combustible cigarette; Electronic cigarette; Smoking; Stroke.