World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 13, Number 1, February 2022, pages 20-26

Cancer Prevalence in E-Cigarette Users: A Retrospective Cross-Sectional NHANES Study

**Table 1.** Epidemiological Characteristics of Cancer Respondents
Variable	E-cigarette, N = 7,756 (5.01%)	Traditional smoking, N = 48,625 (31.4%)	No smoking, N = 98,475 (63.6%)	Total, N = 154,856 (100%)	P value
SE: standard error.
Age (median (Q1-Q3))	25 (20 - 31)	62 (50 - 71)	50 (34 - 64)		< 0.0001
Gender (%)					< 0.0001
Male	51	62	38	46
Female	49	38	62	54
Race (%)					< 0.0001
White	28	42	30	34
African American	23	21	20	20
Mexican American	20	13	17	16
Other Hispanic	11	12	12	12
Asian	12	7	18	14
Other race	7	5	3	4
Annual household income					< 0.0001
$0 - 24,999	27	32	24	27
$25,000 - 64,999	32.2	38.6	34.5	35.7
$65,000 - 99,999	17	14	17	16
$100,000 and over	24	15.6	24.3	21.5
Comorbidities
Hypertension	68	80	80.3	80	< 0.0001
Diabetes mellitus	3.3	22.1	14.0	16.0	< 0.0001
Hypercholesterolemia	10.6	46	35	37	< 0.0001
Coronary heart disease	1.5	8.5	3.3	5.0	< 0.0001
Stroke	1.1	6.7	3.2	4.3	< 0.0001
Marijuana or Hashish	79	70.3	32.3	44.8	< 0.0001
Cocaine/heroin/methamphetamine	12.8	27.1	5.1	11.8	< 0.0001
Injectable illegal drug	1.1	4.2	0.4	1.5	< 0.0001
Alcohol use disorder	69.5	46.3	38.6	43.3	< 0.0001
Anemia	4.0	4.4	4.6	4.5	0.0012
Depression	28.1	23.5	20	22	< 0.0001
Liver disease	2.5	7.2	4.1	5.1	< 0.0001
Serum cotinine (ng/mL), mean ± SE	20.8 ± 0.9	67.2 ± 0.6	6.8 ± 0.17		< 0.0001
Serum hydroxy cotinine (ng/mL), mean ± SE	8.1 ± 0.43	27.4 ± 0.30	3.2 ± 0.1		< 0.0001

Table 1. Epidemiological Characteristics of Cancer Respondents

Variable

E-cigarette, N = 7,756 (5.01%)

Traditional smoking, N = 48,625 (31.4%)

No smoking, N = 98,475 (63.6%)

Total, N = 154,856 (100%)

P value

SE: standard error.

Age (median (Q1-Q3))

25 (20 - 31)

62 (50 - 71)

50 (34 - 64)

< 0.0001

Gender (%)

< 0.0001

Male

Female

Race (%)

< 0.0001

White

African American

Mexican American

Other Hispanic

Asian

Other race

Annual household income

< 0.0001

$0 - 24,999

$25,000 - 64,999

32.2

38.6

34.5

35.7

$65,000 - 99,999

$100,000 and over

15.6

24.3

21.5

Comorbidities

Hypertension

80.3

< 0.0001

Diabetes mellitus

3.3

22.1

14.0

16.0

< 0.0001

Hypercholesterolemia

10.6

< 0.0001

Coronary heart disease

1.5

8.5

3.3

5.0

< 0.0001

Stroke

1.1

6.7

3.2

4.3

< 0.0001

Marijuana or Hashish

70.3

32.3

44.8

< 0.0001

Cocaine/heroin/methamphetamine

12.8

27.1

5.1

11.8

< 0.0001

Injectable illegal drug

1.1

4.2

0.4

1.5

< 0.0001

Alcohol use disorder

69.5

46.3

38.6

43.3

< 0.0001

Anemia

4.0

4.4

4.6

4.5

0.0012

Depression

28.1

23.5

< 0.0001

Liver disease

2.5

7.2

4.1

5.1

< 0.0001

Serum cotinine (ng/mL), mean ± SE

20.8 ± 0.9

67.2 ± 0.6

6.8 ± 0.17

< 0.0001

Serum hydroxy cotinine (ng/mL), mean ± SE

8.1 ± 0.43

27.4 ± 0.30

3.2 ± 0.1

< 0.0001

**Table 2.** Univariate Analysis of Association of Smoking With Cancer
Variable	E-cigarette, N = 7,756 (5.01%)	Traditional smoking, N = 48,625 (31.4%)	No smoking, N = 98,475 (63.59%)	Total, N = 154,856 (100%)	P value
Cancer (%)	2.32	16.8	9.5	11.6	< 0.0001
Age at first cancer (median (Q1-Q3))	45 (40 - 62)	63 (52 - 72)	59 (47 - 69)	NA	< 0.0001
Types of cancer (prevalence %)
Lung	0	3.0	0.6	1.7	< 0.0001
Bladder	0	4.8	2.2	3.4	< 0.0001
Breast	12.1	12.0	20.4	16.4	< 0.0001
Leukemia	8.5	1.1	1.7	1.5	< 0.0001
Cervical	22	2.6	2.6	2.8	< 0.0001
Colon	0	5.2	6.9	6.1	< 0.0001
Melanoma	3.5	7.5	6.0	6.7	< 0.0001
Skin (non-melanoma)	15.6	12.3	15.9	14.2	< 0.0001
Skin (other)	27.7	9.5	6.2	7.9	< 0.0001
Prostate	0	20.1	15.2	17.7	< 0.0001
Thyroid	10.6	2.4	2.6	2.6	< 0.0001
Uterus	0	2.6	4.8	3.7	< 0.0001
Lymphoma/Hodgkin’s disease	0	1.7	2	1.9	< 0.0001
Kidney	0	2.0	2.0	2.0	< 0.0001

Table 2. Univariate Analysis of Association of Smoking With Cancer

Variable

E-cigarette, N = 7,756 (5.01%)

Traditional smoking, N = 48,625 (31.4%)

No smoking, N = 98,475 (63.59%)

Total, N = 154,856 (100%)

P value

Cancer (%)

2.32

16.8

9.5

11.6

< 0.0001

Age at first cancer (median (Q1-Q3))

45 (40 - 62)

63 (52 - 72)

59 (47 - 69)

< 0.0001

Types of cancer (prevalence %)

Lung

3.0

0.6

1.7

< 0.0001

Bladder

4.8

2.2

3.4

< 0.0001

Breast

12.1

12.0

20.4

16.4

< 0.0001

Leukemia

8.5

1.1

1.7

1.5

< 0.0001

Cervical

2.6

2.8

< 0.0001

Colon

5.2

6.9

6.1

< 0.0001

Melanoma

3.5

7.5

6.0

6.7

< 0.0001

Skin (non-melanoma)

15.6

12.3

15.9

14.2

< 0.0001

Skin (other)

27.7

9.5

6.2

7.9

< 0.0001

Prostate

20.1

15.2

17.7

< 0.0001

Thyroid

10.6

2.4

2.6

< 0.0001

Uterus

2.6

4.8

3.7

< 0.0001

Lymphoma/Hodgkin’s disease

1.7

1.9

< 0.0001

Kidney

2.0

< 0.0001

**Table 3.** Adjusted Multivariate Analysis of Association Between Cancer and Smoking
Variable	Cancer (OR (95% CI); P value)
OR: odds ratio; CI: confidence interval.
No smoking	Reference
E-cigarette	2.2 (2.2 - 2.3); P < 0.0001
Traditional smoking	1.96 (1.96 - 1.97); P < 0.001
Gender (%)
Male	Reference
Female	1.67 (1.675 - 1.678); P < 0.001
Race (%)
Mexican American	Reference
White	2.56 (2.56 - 2.57); P < 0.001
African American	1.51 (1.50 - 1.51); P < 0.001
Other Hispanic	1.92 (1.91 - 1.92); P < 0.001
Asian	1.81 (1.80 - 1.81); P < 0.001
Other race	0.48 (0.47 - 0.48); P < 0.001
Annual household income
$0 - 24,999	Reference
$25,000 - 64,999	2.25 (2.24 - 2.25); P < 0.001
$65,000 - 99,999	0.67 (0.66 - 0.67); P < 0.001
$100,000 and over	1.72 (1.71 - 1.72); P < 0.001
Comorbidities
Hypertension	1.44 (1.43 - 1.44); P < 0.001
Hypercholesterolemia	1.11 (1.11 - 1.12); P < 0.001
Diabetes mellitus	1.47 (1.43 - 1.44); P < 0.001
Anemia	3.74 (3.73 - 3.74); P < 0.001
Marijuana or Hashish	1.25 (1.24 - 1.25); P < 0.001
Cocaine/heroin/methamphetamine	0.46 (0.45 - 0.46); P < 0.001
Injectable illegal drug	1.45 (1.44 - 1.46); P < 0.001
Stroke	1.56 (1.56 - 1.57); P < 0.001
Alcohol use disorder	0.94 (0.94 - 0.94); P < 0.001

Table 3. Adjusted Multivariate Analysis of Association Between Cancer and Smoking

Variable

Cancer (OR (95% CI); P value)

OR: odds ratio; CI: confidence interval.

No smoking

Reference

E-cigarette

2.2 (2.2 - 2.3); P < 0.0001

Traditional smoking

1.96 (1.96 - 1.97); P < 0.001

Gender (%)

Male

Reference

Female

1.67 (1.675 - 1.678); P < 0.001

Race (%)

Mexican American

Reference

White

2.56 (2.56 - 2.57); P < 0.001

African American

1.51 (1.50 - 1.51); P < 0.001

Other Hispanic

1.92 (1.91 - 1.92); P < 0.001

Asian

1.81 (1.80 - 1.81); P < 0.001

Other race

0.48 (0.47 - 0.48); P < 0.001

Annual household income

$0 - 24,999

Reference

$25,000 - 64,999

2.25 (2.24 - 2.25); P < 0.001

$65,000 - 99,999

0.67 (0.66 - 0.67); P < 0.001

$100,000 and over

1.72 (1.71 - 1.72); P < 0.001

Comorbidities

Hypertension

1.44 (1.43 - 1.44); P < 0.001

Hypercholesterolemia

1.11 (1.11 - 1.12); P < 0.001

Diabetes mellitus

1.47 (1.43 - 1.44); P < 0.001

Anemia

3.74 (3.73 - 3.74); P < 0.001

Marijuana or Hashish

1.25 (1.24 - 1.25); P < 0.001

Cocaine/heroin/methamphetamine

0.46 (0.45 - 0.46); P < 0.001

Injectable illegal drug

1.45 (1.44 - 1.46); P < 0.001

Stroke

1.56 (1.56 - 1.57); P < 0.001

Alcohol use disorder

0.94 (0.94 - 0.94); P < 0.001