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Regular Cannabis Use, With and Without Tobacco Co-Use, Is Associated With Respiratory Disease


Regular Cannabis Use, With and Without Tobacco Co-Use, Is Associated With Respiratory Disease

Theresa Winhusen et al. Drug Alcohol Depend.


Background: Cannabis use is a potential risk factor for respiratory disease but its role apart from tobacco use is unclear. We evaluated the association between regular cannabis use, with and without tobacco co-use, and onset of asthma, chronic obstructive pulmonary disease (COPD), and pneumonia.

Methods: Analysis of a limited data set obtained through IBM Watson Health Explorys, an electronic-health-record-integration platform. Matched controls using Mahalanobis distance within propensity score calipers were defined for: 1) cannabis-using patients (n = 8932); and subgroups of cannabis-using patients: 2) with an encounter diagnosis for tobacco use disorder (TUD; n = 4678); and 3) without a TUD diagnosis (non-TUD; n = 4254). Patients had at least: one recorded blood pressure measurement and one blood chemistry lab result in the MetroHealth System (Cleveland, Ohio). Cannabis-using patients had an encounter diagnosis of cannabis abuse/dependence and/or ≥2 cannabis-positive urine drug screens (UDSs). Control patients, not having cannabis-related diagnoses or cannabis-positive UDSs, were matched to the cannabis-using patients on demographics, residential zip code median income, body mass index, and, for the total sample, TUD-status.

Results: Regular cannabis use was significantly associated with greater risk for asthma (odds ratio (OR) = 1.44; adjusted odds ratio (aOR) = 1.50; OR = 1.32), COPD (OR = 1.56; aOR = 1.44; OR = 2.17), and pneumonia (OR = 1.80; OR = 1.84; OR = 2.13) in the total sample and TUD and non-TUD subgroups, respectively. TUD-patients had the greatest prevalence of respiratory disease, regardless of cannabis-use indication.

Conclusions: Regular cannabis use is associated with significantly greater risk of respiratory disease regardless of TUD status. Future research to understand the impact of cannabis use on respiratory health is warranted.

Keywords: Cannabis; Electronic Health Record (EHR); Respiratory.

Conflict of interest statement

Declarations of interest: TW, JT, and DL declare no conflicts of interest. DCK is the Chief Medical Informatics Officer of the MetroHealth System. In exchange for contributing de-identified data to the Explorys network, the MetroHealth System receives access to the Explorys Cohort Discovery tool, which was used to conduct this study. Neither DCK nor the MetroHealth System have any direct financial ties to Explorys (IBM Watson Health).

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