Arthritis served as the outcome variable, while vaping and smoking were the exposure variables. Estimates were conditioned on twenty-seven demographic, behavioral, and health-related covariates. The results showed that vaping was associated with a 2.12 percentage point higher prevalence of arthritis than among non-vapers, while smoking was associated with a 2.22 percentage point increase compared with non-smokers.

When concurrent nicotine behaviors were accounted for, the estimates remained largely stable, with smoking showing a slightly larger association of 2.14 percentage points and vaping attenuating to 1.91 percentage points. Because arthritis is highly prevalent and costly, the researchers also produced illustrative projections of the potential economic implications of the arthritis cases associated with these behaviors. Vaping was estimated to be associated with approximately 190,581 to 254,109 arthritis cases annually, corresponding to a projected cost of 133.4 to 177.9 million dollars.

Smoking was statistically associated with approximately 518,886 to 687,413 cases per year, corresponding to a projected 363.2 to 481.2 million dollars. Under conservative assumptions, the combined burden associated with vaping and smoking amounted to roughly 496.8 to 659.1 million dollars annually. The authors note that these projections represent approximately 0.09 to 0.22 percent of published estimates of total U.S. arthritis-related expenditures under direct healthcare cost assumptions.

The authors emphasize that the figures are illustrative projections rather than established costs, and that the reported estimates are statistical associations conditioned on measured covariates rather than proof of causation. Even so, the central result is striking: the arthritis association observed for vaping was comparable to, and in some specifications potentially exceeded, the estimate for smoking. The authors state that their findings do not support the perception of vaping as a risk-free alternative, and they suggest that the projections may inform policy discussions on vaping and smoking in relation to the broader arthritis-related health and economic burden.

The study's scope carries important caveats. Within those limits, the research offers a quantified picture of how closely vaping tracks smoking in its statistical association with arthritis, and it provides cost projections that the authors hope will contribute to ongoing policy debates about e-cigarette regulation and the wider burden of nicotine use on public health.

Subject of Research: Associations of vaping and smoking with arthritis prevalence and projected economic costs among U.S. adults

Article Title: Vaping and smoking as risk factors for arthritis: Evidence from double machine learning

Article References: Chike, O. E., Badruddoza, S., & Lyford, C. (2026). Vaping and smoking as risk factors for arthritis: Evidence from double machine learning. PLOS One, 21(10), e0360863. https://doi.org/10.1371/journal.pone.0360863

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360863

Keywords: vaping, smoking, arthritis, double machine learning, BRFSS, e-cigarettes, musculoskeletal health, economic burden, nicotine, public health, risk factors, CDC