By: Brantley Scott
According to Yale Medicine, e-cigarette and vaping associated lung illness (EVALI) is defined as a significant medical condition in which a patient’s lungs become injured from ingredients contained in e-cigarettes and vaping products. Symptoms of EVALI can include, but are not limited to, shortness of breath, rapid heartbeat, and shallow breathing. The main cause of EVALI according to a study published in 2019 was Vitamin E Acetate which was found to have damaged the lungs of patients who used e-cigarettes (“E-cigarette, or Vaping Product, Use Associated Lung Injury (EVALI)”).
The use of e-cigarettes has risen in recent years. According to the State Health Access Data Assistance Center’s (SHADAC’s) analysis of the Behavioral Risk Factor Surveillance System (BRFSS), Utah has consistently been in the top third of states with the highest percentage of adult e-cigarette use. Utah’s e-cigarette use rates are highest among older teenagers and young adults (Utah TPCP Annual Report FY2020). Although the full spectrum of possible health impacts of e-cigarette use is not known, mounting evidence points to harmful consequences. Additionally, there are a sizable number of EVALI cases in Utah. In this report, we examine some of the characteristics of patients who were admitted to Utah hospitals with an EVALI diagnosis code (ICD 10: U070).
The data used in this report comes from the Utah Healthcare Facilities Database (HFD) and the All Payers Claim Database (APCD). EVALI cases were identified from encounters or claims in 2020 with a diagnosis code of “U070”. There were 118 encounters identified in the HFD and 49 of these claims in the APCD.
The demographics of patients diagnosed with EVALI varied widely. More than half of the patients admitted to the hospital were male (58%) and slightly less than half were female (42%). The median age was 25 years old, but ages ranged from 14 to 80 years old. Fifteen percent of the encounters were people who identify as Hispanic or Latino. The figure below depicts the age and sex distribution of the patients who were admitted to the hospital with an EVALI diagnosis code.
Figure 1. Number of inpatient stays for EVALI in Utah by age group and sex, 2020.
The length of stay for those admitted to the hospital with EVALI also varied with some staying less than a day, while the maximum stay was 23 days. While both males and females had inpatient stays in every age group, the number of male hospitalizations in the 14–17, 18–24, and 25–34 was greater than the number of female hospitalizations.The average length of stay was 4.5 days, with about 75% of the stays ranging between two and six days.
The chart below shows both males and females had a wide range in EVALI hospitalization length of stay. The average length of stay for males was 4.1 days while the average length of stay for females was 4.9 days.
Figure 2. Number of inpatient stays for EVALI in Utah by length of stay (days) and sex, 2020.
One of the contributing factors for length of stay may be other diagnoses the patients had while in the hospital. Some of the common additional diagnosis codes these claims had indicated the patients suffered from acute respiratory failure (75 patients; 64%), anxiety and/or major depressive disorder (39 patients; 33%), cannabis use (36 patients; 31%), sepsis (28 patients; 24%), and pneumonia (26 patients; 22%). There were six (5%) cases where patients tested positive for COVID-19.
One final area that was investigated was cost of these inpatient stays. While the APCD does not contain all claims for all patients admitted to the hospital, it contains sufficient data to determine cost estimates. Costs were calculated by summing the amount the insurance paid as well as the member liability amounts (co-pay, coinsurance, and deductible). The average cost for an inpatient stay was $14,517, and ranged from $1,399 up to $62,046. The age group with the highest average hospitalization cost was adolescents aged 14–17 with an average cost of $20,531 per inpatient stay. The age group with the lowest average hospitalization cost was adults aged 25–34 with the average cost of $8,574 per inpatient stay. The figure below shows the average cost of EVALI hospitalizations broken down by age group.
Figure 3. Average cost of inpatient stays for EVALI in Utah, by age group, 2020.
Due to the small number of claims for the 45–54, 55–64, and 65+ age groups, these age groups were combined to ensure that there were at least seven claims in each age category. Due in part to a small number of claims and high variation within the age groups, the only age group with a statistically significant difference from the overall average cost was 25–34. This age group’s lower than average cost, compared with the overall average, was not due solely to random chance.
While many health considerations regarding the use of e-cigarettes and vaping remain unknown, our analysis of the Utah Healthcare Facilities Database and the All Payer Claims Database shows a wide variety of patient demographics and costs for those admitted to Utah hospitals with an EVALI diagnosis. For more information about this report, please contact Brantley Scott at firstname.lastname@example.org. For more information on tobacco and vape product use and quitting, please visit the Utah Tobacco Prevention Program quit website waytoquit.org.
 Statehealthcompare.shadac.org. 2021. Rank | Percent of adults who currently use e-cigarettes some days or every day by Total | State Health Access Data Assistance Center. Retrieved September 20th, 2021 from http://statehealthcompare.shadac.org/rank/217/percent-of-adults-who-currently-use-ecigarettes-some-days-or-every-day-by-total#1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52/a/25/251/false/highest.
 Utah Department of Health. Tobacco Prevention and Control Program. 2021. Tobacco Prevention and Control in Utah. Retrieved September 30th, 2021 from https://tobaccofreeut.wpengine.com/wp-content/uploads/2020-TPCP-Annual-Report-final.pdf
 Lung.org. 2021. Health Risks of E-Cigarettes and Vaping. Retrieved September 20th, 2021 from https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on-lung.