Vaping-Related ER Visits on the Rise in KY Youth
A new data report from the Kentucky Injury Prevention and Research Center (KIPRC) reveals a sharp increase in emergency department (ED) visits related to e-cigarette dependence and nicotine toxicity among Kentucky residents between 2018 and 2024, with some of the steepest rises occurring among youth and young adults.
The analysis, conducted by KIPRC epidemiologists Mira Mirzaian, MPH, and Lara Daniels, MPH, used data from the Kentucky Outpatient Services Database, maintained by the Office of Data Analytics within the Cabinet for Health and Family Services.
“This database captures emergency department encounters across the state and serves as a key source for monitoring substance use-related morbidity,” Mirzaian said. “In addition to outpatient records, we include a subset of inpatient hospitalization, specifically cases where patients were admitted directly from the ED to a non-ambulatory inpatient facility.”
E-cigarette dependence-related visits among Kentuckians under age 18 rose from fewer than 300 in 2018 to over 2,700 in 2024, while visits among adults aged 25 and older more than quadrupled during the same period.
“That kind of sustained growth among adolescents is particularly concerning,” said Mirzaian.
The analysis used an “any mention” approach, meaning cases were included if a nicotine-related ICD-10 code appeared anywhere in the medical record. ICD-10 refers to the International Classification of Diseases, Tenth Revision, a medical classification system used to classify and code diseases, symptoms, and procedures.)
“This is a common surveillance strategy that helps ensure we don’t miss relevant cases, especially when nicotine use is a contributing factor rather than the main reason for the visit,” Mirzaian said.
That said, ED visits only represent a small portion of total e-cigarette use. This data reflects acute cases that required medical attention, not the full extent of use in the state.
The rise in ED visits may reflect multiple overlapping issues. Mirzaian said the trends likely reflect a combination of factors.
“The steady rise in ED visits involving youth over time may indicate increased use and, in some cases, more acute/severe health effects requiring emergency care,” she said. “At the same time, there’s been growing clinical awareness of vaping-related harms, along with broader adoption of nicotine-specific ICD-10 codes.”
The data show a sharp rise in Kentucky resident emergency department visits coded with “vaping-related disorder” (ICD-10 U07.0), a diagnosis code introduced in October 2022. While the initial jump in cases may be tied to the adoption of this new code, the continued rise into 2024 suggests something that there may be a real increase in vaping-related health harms, something researchers say warrants further exploration.
“From 2023 to 2024, the number of cases continued to rise, especially among adults [aged 25+], which suggests that the increase may not be due to coding alone,” Mirzaian said. “It’s possible that we’re seeing a true rise in serious vaping-related health consequences.”
Disparities across sex were also noted in the report. In 2024, for the first time, females surpassed males in the number of e-cigarette dependence-related visits, accounting for nearly 49,000 visits to Kentucky EDs.
“The overall trend reflects a narrowing sex gap, something we’ve also observed in broader substance use surveillance data,” said Mirzaian.
Racial and ethnic disparities were evident as well.
“Non-Hispanic White residents continued to represent the largest proportion of ED visits, but increases among Non-Hispanic Black and Hispanic residents were also substantial,” said Mirzaian. “For example, ED visits among Hispanic Kentuckians rose from 178 in 2018 to over 1,700 in 2024, suggesting a broadening impact across demographic groups.”
Although less common than dependence-related visits, emergency department visits related to acute nicotine poisoning also rose in 2024, particularly among youth. The researchers plan to continue tracking these indicators.
“Given that nicotine dependence, especially among youth and young adults, remains an area of ongoing concern, we fully intend to continue tracking these indicators on an annual basis,” Mirzaian said. “Our goal is to provide stakeholders with the timely, actionable data they need to monitor trends and inform targeted prevention efforts in their communities.”
The report can be found on the KIPRC website at https://kiprc.uky.edu/sites/default/files/2025-06/2024_nicotine_ecigarette_report.pdf.
KIPRC, a unique partnership between the Kentucky Department for Public Health (DPH) and CPH, serves both as an academic injury prevention research center and as the DPH’s designee or “bona fide agent” for statewide injury prevention and control, focusing on injury prevention translation and practice.