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Introduction <p>The increasing use of electronic cigarettes (e-cigarettes) has raised concerns regarding their potential health effects, including ocular outcomes such as age-related macular degeneration (AMD). While conventional cigarette smoking is a well-established risk factor for AMD, the associations of exclusive e-cigarette use and former smoking with early AMD remain unclear.</p> Methods <p>We analyzed 7,780 adults aged ≥ 40 years from the Korea National Health and Nutrition Examination Survey (2016–2021). Based on self-reported smoking history and e-cigarette use, participants were classified as non-smokers, former smokers, or exclusive e-cigarette users. Early AMD was assessed through standardized ophthalmologic examinations conducted by trained ophthalmologists. Biomarkers of nicotine exposure (urinary cotinine), systemic inflammation (hsCRP), and oxidative stress (vitamin E) were compared across groups. Survey-weighted logistic regression evaluated associations with early AMD.</p> Results <p>Exclusive e-cigarette users had markedly higher nicotine exposure than non-smokers (<i>P</i> &lt; 0.001). Both former smokers and exclusive e-cigarette users showed higher log-transformed hsCRP than non-smokers (both <i>P</i> &lt; 0.01), whereas vitamin E did not differ significantly. In adjusted models, exclusive e-cigarette use was not significantly associated with early AMD (AOR = 1.25; 95% CI: 0.73–2.16), whereas former smoking showed a modest association (AOR = 1.30; 95% CI: 1.02–1.64). Among exclusive e-cigarette users, LOWESS analyses suggested an increasing trend in AMD probability with higher cotinine levels.</p> Conclusions <p>We did not observe a statistically significant association between exclusive e-cigarette use and early AMD in adjusted analyses, although exploratory analyses suggested a possible increase in AMD probability with higher urinary cotinine levels among exclusive e-cigarette users. In contrast, former smoking showed a modest association with early AMD. Given the relatively small number of exclusive e-cigarette users and the cross-sectional design, a modest association cannot be ruled out. Further longitudinal studies are needed to clarify the long-term ocular effects of e-cigarette use.</p>

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Exclusive e-cigarette use, nicotine exposure, and early age-related macular degeneration in South Korean adults

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Baksun Sung,
  • Youngsub Eom,
  • Jong Suk Song,
  • Yoon-Hyeong Choi,
  • Dong Hyun Kim

摘要

Introduction

The increasing use of electronic cigarettes (e-cigarettes) has raised concerns regarding their potential health effects, including ocular outcomes such as age-related macular degeneration (AMD). While conventional cigarette smoking is a well-established risk factor for AMD, the associations of exclusive e-cigarette use and former smoking with early AMD remain unclear.

Methods

We analyzed 7,780 adults aged ≥ 40 years from the Korea National Health and Nutrition Examination Survey (2016–2021). Based on self-reported smoking history and e-cigarette use, participants were classified as non-smokers, former smokers, or exclusive e-cigarette users. Early AMD was assessed through standardized ophthalmologic examinations conducted by trained ophthalmologists. Biomarkers of nicotine exposure (urinary cotinine), systemic inflammation (hsCRP), and oxidative stress (vitamin E) were compared across groups. Survey-weighted logistic regression evaluated associations with early AMD.

Results

Exclusive e-cigarette users had markedly higher nicotine exposure than non-smokers (P < 0.001). Both former smokers and exclusive e-cigarette users showed higher log-transformed hsCRP than non-smokers (both P < 0.01), whereas vitamin E did not differ significantly. In adjusted models, exclusive e-cigarette use was not significantly associated with early AMD (AOR = 1.25; 95% CI: 0.73–2.16), whereas former smoking showed a modest association (AOR = 1.30; 95% CI: 1.02–1.64). Among exclusive e-cigarette users, LOWESS analyses suggested an increasing trend in AMD probability with higher cotinine levels.

Conclusions

We did not observe a statistically significant association between exclusive e-cigarette use and early AMD in adjusted analyses, although exploratory analyses suggested a possible increase in AMD probability with higher urinary cotinine levels among exclusive e-cigarette users. In contrast, former smoking showed a modest association with early AMD. Given the relatively small number of exclusive e-cigarette users and the cross-sectional design, a modest association cannot be ruled out. Further longitudinal studies are needed to clarify the long-term ocular effects of e-cigarette use.