Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Cannabis is one of the most commonly used psychoactive substances worldwide, with 20% of adults in the U.S. reporting using cannabis at least once in the past year. Nicotine dependence is reported in 9% to 10% of adults in the U.S.1 This study aims to investigate the relationship between cannabis use and cigarette smoking on mortality, cardiovascular outcomes, suicide, cancer of the lung and bronchus, and reactive airway disease in emergency department (ED) patients.

Methods: This retrospective, propensity score–matched study used the TriNetX database to analyze records of 120,689,106 patients from 69 healthcare organizations in the U.S. between 2005 and 2022. The first cohort consisted of adult patients and was grouped based on diagnosis of cannabis-related disorders (CRD) within five years before or one month after an ED visit. The second cohort consisted of adult patients with a diagnosis of “nicotine dependence, cigarettes” within five years before to one month after an ED visit. The outcomes evaluated were all-cause mortality, stroke, myocardial infarction, suicide, cancer of the lung and bronchus, and reactive airway disease (asthma/chronic obstructive pulmonary disease [COPD]) within three years after the ED visit. Patients who previously experienced these outcomes or belonged to both cohorts were excluded from the study. We performed 1:1 greedy nearest-neighbor propensity score matching for demographics and seven preexisting conditions associated with mortality.

Results: There were 1,682,117 patients identified with ED visits and CRD or cigarette smoking. After propensity score matching, there were a total of 651,232 adult patients with CRD (n = 325,616) or cigarette smoking (n = 325,616) within five years prior or one month after an ED visit. Patients with CRD were associated with a significantly higher mortality rate (2.35% vs 2.16%; relative risk [RR] 1.09; 95% CI, 1.05-1.12; P < .001), stroke (0.45% vs 0.28%; RR 1.59; 95% CI, 1.47-1.73; P < .001), myocardial infarction (0.53% vs 0.35%; RR 1.51; 95% CI, 1.40-1.63; P < .001) and suicide (0.62% vs 0.35%; RR 1.77; 95% CI, 1.65–1.90; P < .001) within 3-years of the ED visit compared to patients smoking cigarettes. Individuals with CRD were associated with a significantly lower rate of lung and bronchus cancer (0.16% vs 0.31%; RR 0.53; 95% CI, 0.48–0.59; P < .001) and reactive airway disease; asthma (6.30% vs 7.37%; RR 0.86; 95% CI, 0.84–0.87; P < .001) and COPD (1.65% vs 3.05%; RR 0.54; 95% CI, 0.52-0.56; P < .001) than those with cigarette smoking.

Conclusion: We found that cannabis use was associated with higher risks of mortality, stroke, myocardial infarction, and suicide for ED patients when compared to cigarette smoking. Cannabis-related disorder was associated with lower rates of reactive airway disease and lung and bronchus cancer when compared to those with cigarette smoking.