Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010, USA.
Department of Biostatistics, School of Global Public Health, New York University, New York, NY 10003, USA.
Int J Environ Res Public Health. 2021 Oct 2;18(19):10402. doi: 10.3390/ijerph181910402.
E-cigarette use (vaping) is an emerging public health problem. Depression has been found to be associated with e-cigarette use, and vaping and depression are each associated with elevated systemic inflammation. To date, the role of inflammation in the relationship between vaping and depression has not been explored.
To assess the independent associations between e-cigarette use, depression, and inflammation, and to investigate whether the likelihood of depression among current e-cigarette users is associated with systemic inflammation.
Nationally representative NHANES data from 2015-2018 were used ( = 4961). Systemic inflammation was defined as serum C-reactive protein (CRP) ≥ 8.0 mg/L. Depressed individuals were characterized by a score ≥ 10 on the Patient Health Questionnaire-9 (PHQ-9). Current e-cigarette users were defined as individuals who vaped at least once in the past 30 days and these individuals were stratified by use: exclusive users (reported smoking less than 100 combustible cigarettes in their lifetime), dual users (reported current use of electronic and combustible cigarettes), and e-cigarette users who were previous smokers. Bivariate analyses were used to assess independent associations between vaping, depression, and inflammation; and weighted logistic regression analyses adjusting for BMI, sex, and economic status were used to determine the odds ratios (ORs) for depression by e-cigarette category stratified by differential CRP levels.
Depression occurred in 16.7% of all e-cigarette users vs. 5.0% of those who never used e-cigarettes ( < 0.001). In adjusted analyses, the following elevated ORs were found: all current e-cigarette users with CRP <8 = 3.37 (95% CI: 2.06, 5.51) vs. CRP ≥8 = 6.70 (2.48, 18.11); exclusive e-cigarette users with CRP <8 = 1.91 (0.78, 4.69) vs. those with CRP ≥8 = 5.09 (1.44, 18.02); and dual users with CRP <8 = 4.31 (2.35, 7.89) vs. those with CRP ≥8 = 7.37 (1.85, 29.41). These ORs indicate that depression is associated with each category of e-cigarette use; however, we found this association did not vary by systemic inflammation level (interaction -values > 0.05).
While a pattern of greater ORs for depression among e-cigarette users with elevated CRP provides provocative findings that might suggest a potential role of inflammation in the association between vaping and depression, we failed to find evidence that inflammation clearly moderates this association. While it is possible that depression among e-cigarette users may be influenced by systemic inflammation, a reproduction of the current study is necessary among a larger cohort to elucidate the effect of inflammation on depression among e-cigarette users.
电子烟的使用（ vaping ）是一个新出现的公共卫生问题。已经发现抑郁症与电子烟的使用有关，而电子烟的使用和抑郁症都与全身性炎症的升高有关。迄今为止，炎症在电子烟使用与抑郁症之间的关系中的作用尚未得到探索。
评估电子烟使用、抑郁症和炎症之间的独立关联，并探讨当前电子烟使用者中抑郁症的可能性是否与全身性炎症有关。
使用了来自 2015-2018 年的具有全国代表性的 NHANES 数据（ n ＝4961）。全身性炎症定义为血清 C 反应蛋白（ CRP ）≥8.0mg/L。有抑郁症状的个体的特点是 PHQ-9 得分≥10 分。当前的电子烟使用者被定义为过去 30 天内至少吸过一次电子烟的人，这些人根据使用情况分为以下几类：专用使用者（报告一生中吸烟少于 100 支可燃香烟）、双重使用者（报告目前同时使用电子烟和可燃香烟）和以前吸烟但现在使用电子烟的使用者。采用双变量分析评估电子烟使用、抑郁症和炎症之间的独立关联；并采用调整 BMI、性别和经济状况的加权 logistic 回归分析，根据 CRP 水平的差异，确定按电子烟类别分层的抑郁症的优势比（ OR ）。
在所有电子烟使用者中，有 16.7%的人患有抑郁症，而从未使用过电子烟的人则为 5.0%（<0.001）。在调整后的分析中，发现以下 OR 值升高： CRP <8 的所有当前电子烟使用者为 3.37（95%CI：2.06，5.51），CRP≥8 的为 6.70（2.48，18.11）； CRP <8 的专用电子烟使用者为 1.91（0.78，4.69），CRP≥8 的为 5.09（1.44，18.02）； CRP <8 的双重使用者为 4.31（2.35，7.89），CRP≥8 的为 7.37（1.85，29.41）。这些 OR 表明，抑郁症与电子烟的每一类使用都有关联；然而，我们发现这种关联与全身性炎症水平无关（交互值>0.05）。
虽然 CRP 升高的电子烟使用者中抑郁症的 OR 值更高的模式提供了令人关注的发现，这些发现可能表明炎症在电子烟使用与抑郁症之间的关联中可能发挥作用，但我们未能发现炎症明显调节这种关联的证据。虽然电子烟使用者的抑郁症可能受到系统性炎症的影响，但有必要在更大的队列中重复当前的研究，以阐明炎症对电子烟使用者中抑郁症的影响。
