OBJECTIVES: In 2019 there was an outbreak of e-cigarette, or vaping product use-associated lung injury (EVALI) resulting in hospitalizations and deaths in the US. The objective of this study was to assess the risk factors and healthcare cost associated with bronchiolitis obliterans (popcorn lung) and candida albicans (fungal infections) among patients with EVALI.

METHODS: A cross-sectional analysis of respondents surveyed through Medical Expenditure Panel Survey (MEPS) in 2020 who experienced an EVALI event (ICD-10: U07) was conducted. Survey respondent health behaviors, comorbidities and healthcare use were assessed. Descriptive statistics were calculated for factors including means and standard deviations as well as frequency and percentages. Logistic regression models predicting popcorn lung (J44) and fungal infections (B37) were developed and included risk factors associated with EVALI.

RESULTS: 970 survey respondents from the 2020 MEPS experienced an EVALI event. The sample was primarily female (58.5%), white (79.0%), employed (59.0%). The mean age was 44.2 years (SD 20.7). Few had a history of smoking (18.1%), regular exercise (38.5%), regular alcohol use weekly or greater (15.3%). The sample was relatively healthy: 16.6% had asthma; 11.4% had a history of cancer; 14.2% reported being depressed; 7.3% had a history of diabetes; and 5.6% had coronary heart disease. 103 respondents reported hospitalizations and 187 reported emergency department visits. Only 7 respondents reported popcorn lung and 9 reported fungal infections. Mean per respondent healthcare expenditures was $10,950 (SD 29,878), with popcorn lung $109,025 (SD 150,618) and fungal infection $13,947 (SD 16,495). Factors associated with popcorn lung included asthma (OR 21.60; 2.34-199.06) and history of coronary heart disease (OR 7.31; 1.05-50.71). Only asthma was associated with fungal infection (OR 4.81; 1.15-20.16).

CONCLUSIONS: Asthma was the predominant risk factor for both popcorn lung and fungal infections, while a history of coronary heart disease was also associated with popcorn lung.