Association between electronic cigarettes use and whole blood cell among adults in the USA—a cross-sectional study of National Health and Nutrition Examination Survey analysis

Electronic cigarettes (E-cigarettes) use is an emerging public health problem. Trying to assess the independent associations between E-cigarettes use and whole blood cell in a nationally representative sample of the US adults is very important for the smoking population. Using E-cigarettes data from NHANES (National Health and Nutrition Examination Survey) 2013–2018, 17,180 adults were included in this cross-sectional analysis. All participants were stratified into four different groups (non-smoke group N =10087, E-cigarettes group N =52, dual-smoke group N =249, cigarettes group N =6792) based on questions SMQ020 (smoked at least 100 cigarettes in life) and SMQ690H (used last 5 days E-cigarettes). Whole blood cell tests included white blood cell (WBC) with differentials, red blood cell (RBC) with characteristics, and platelet variables. With adjusted by age, gender, and race ethnicity, multivariate logistic regression analyses were used to assess independent associations between E-cigarettes group and other groups for different whole blood cell variables. A total of 17,180 participants were included in the study; 47.9% were males, with a mean age of 46.99 (±0.29). In WBC-related variables, non-smoke group had the lowest value in WBC counts (7.15±0.05), lymphocyte (2.15±0.02), and monocyte (0.57±0.01), among the four different groups. In RBC-related variables, non-smoke group had the lowest value in mean cell volume (MCV, 88.46±0.14, p <0.05) and mean cell hemoglobin (MCH, 29.73±0.06, p <0.05), among the four different groups. In adjusted analysis, WBC (OR = 0.97, 95% CI: 0.96–0.98, p <0.001), especially lymphocyte (OR = 0.97, 95% CI: 0.96–0.98, p <0.001) and monocyte (OR = 0.11, 95% CI: 0.02–0.66, p <0.001) of non-smoke group, showed negative significant effect for E-cigarettes group. Meanwhile, lower odds of MCV (OR = 0.91, 95% CI: 0.81–1.04, p <0.05) and MCH (OR = 0.81, 95% CI: 0.65–1.00, p <0.05) in non-smoke group were observed compared to E-cigarettes group. Conversely, for dual-smoke group and cigarette group, there was no significant results in all whole blood cell variables compared to E-cigarettes group. E-cigarettes use might be associated with a systemic response that could lead to an increase in WBC, especially lymphocytes and monocytes, in the US adults. Meanwhile, the properties of RBC might also be influenced simultaneously; MCV and MCH in E-cigarettes population were bigger than the non-smoke population.