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Author affiliations. Nicholas T Vozoris 1 2 3 4. Jingqin Zhu 5 6. Clodagh M Ryan 1 7. Chung-Wai Chow 1 7 8. Teresa To 1 2 6 8. Introduction Although cannabis is frequently used worldwide, its impact on respiratory health is characterised by controversy. Objective To evaluate the association between cannabis use and respiratory-related emergency room ER visits and hospitalisations. Methods A retrospective, population-based, cohort study was carried out, linking health survey and health administrative data for residents of Ontario, Canada, aged 12—65 years, between January and December Individuals self-reporting cannabis use within the past year were matched to control individuals people who reported never using cannabis, or used cannabis only once, and more than 12 months ago in upwards of a ratio on 31 different variables, using propensity score matching methods. Respiratory-related and all-cause ER visits or hospitalisations, and all-cause mortality, were evaluated up to 12 months following the index date. Results We identified 35 individuals who had either used cannabis in the past year or were controls, of whom From this group, In the propensity score matched cohort, there was no significant difference in odds of respiratory-related ER visit or hospitalisation between cannabis users and the control group OR 0. Compared with control individuals, cannabis users had significantly increased odds of all-cause ER visit or hospitalisation OR 1. Conclusions Although no significant association was observed between cannabis use and respiratory-related ER visits or hospitalisations, the risk of an equally important morbidity outcome, all-cause ER visit or hospitalisation, was significantly greater among cannabis users than among control individuals. Therefore, cannabis use is associated with increased risk for serious adverse health events and its recreational consumption is not benign. The published literature on cannabis smoking and acute respiratory illness is extremely limited, with one previous study demonstrating that cannabis smoking is associated with higher frequency of protracted acute bronchitis episodes, and another study showing significantly greater outpatient visits for respiratory illness, but not hospitalisations. Our population-based, retrospective, propensity score matched cohort study, involving 15 individuals and extensive covariate adjustment, showed no significant difference in the frequency of respiratory-related emergency room visits or hospitalisations between cannabis users 3. Respiratory-related reasons were the second leading aetiology for all-cause ER visits and hospitalisations among cannabis users. Given that all-cause emergency visits or hospitalisations, which are a clinically important morbidity marker, were significantly greater among cannabis users than among control individuals, and respiratory-related reasons were the second most common cause for emergency visits and hospitalisations in the all-cause outcome, our results suggest that the worldwide rising use of recreational cannabis needs to be curtailed. Cannabis is the most commonly used psychoactive drug worldwide and its use is rising. On the one hand, cannabis smoking has been shown to be associated with the development of chronic bronchitis-type symptoms including chronic cough, chronic sputum production and wheezing , 4 and similar changes of bronchial inflammation are evident on bronchoscopy and endobronchial biopsies among cannabis and tobacco smokers. There is a paucity of data on the association between cannabis smoking and acute respiratory illness. Using linked health survey and health administrative data, our purpose was to evaluate the association between cannabis use and more serious, acute, adverse respiratory events, as identified by emergency room ER presentation or hospital admission for respiratory-related reasons. This was a retrospective, population-based cohort study, linking health survey data with multiple Ontario health administrative databases, for January 1, to December 31, Multiple health-related databases were linked at ICES using unique coded identifiers. The CCHS is national, cross-sectional survey conducted by Statistics Canada every 2 years that collects a broad range of self-reported sociodemographic and health data on a nationally representative sample of the Canadian community-dwelling population aged 12 years and older. Although information on route of cannabis receipt was not collected by CCHS, inhalation is by far the most predominant form of consumption. Ontario residents aged 12—65 years, who participated in either the — or — CCHS, were included. The exposed group consisted of individuals reporting any cannabis use in the preceding 12 months. The control group included individuals who reported never having used cannabis, or having used cannabis only once and more than 12 months ago. The index date for both the exposed and control group was the date of the CCHS interview. We considered codes for asthma and COPD in our primary outcome definition, since these are two commonly encountered chronic airway conditions, characterised by recurrent, acute respiratory exacerbations, which are sometimes serious enough to necessitate presentation to hospital. Secondary outcomes considered were all-cause ER visit or hospitalisation, and all-cause mortality. All outcomes were evaluated up to 12 months following the index date, or up to the date of death, whichever came first. We intentionally limited the time period in which to evaluate outcomes in our main analysis to 12 months following the index date, so as to be reasonably confident that any positive outcomes observed would be linked to exposure status at the time of the index date. In order to minimise bias in our analysis from other variables, propensity score matching methods were used. A full list of variables included in the propensity score can be found in table 1. The supplement contains a detailed description of the variables included in the propensity score. One exposed individual was matched upwards to a maximum of three control individuals for the purpose of enhancing sample size. In accordance with published recommendations, we matched individuals on the logit of the propensity score using a width calliper equal to 0. Several planned sensitivity analyses were undertaken. First, outcomes were examined stratifying by sex, since possible sex-related differences in the association between cannabis use and respiratory health have been up to now little explored. Fourth, we examined outcomes distinguishing by presence of asthma or diagnosis of COPD prior to the index date, in order to determine if risk of cannabis-related adverse respiratory events was greater among individuals with established obstructive airways disease, as some research has suggested. A final sensitivity analysis, evaluating outcomes over a longer 3-year follow-up period after the index date, is presented in the online supplemental file. Descriptive statistics with standardised differences were calculated for all baseline covariates among exposed and control individuals, in order determine the adequacy of the matching process. Number needed to harm NNH was determined by previously described methods. Our study was conducted using deidentified data. There was no direct interaction with any individual participant, and therefore, members of the public were not involved in study design, recruitment or conduct of the study. In the — and — CCHS, there were 35 individuals aged 12—65 years who had used cannabis in the past year or were control individuals. Of these, In the propensity score matched sample, cannabis use frequency among exposed individuals occurred as follows: Flow diagram outlining derivation of the exposed and control groups. In the propensity score matched cohort, odds of respiratory-related ER visit or hospitalisation was not significantly different between exposed and control individuals OR 0. However, compared with the control group, cannabis users had significantly greater odds of all-cause ER visit or hospitalisation OR 1. Examining the top ICD diagnostic codes recorded as etiologies for the all-cause ER visit and hospitalisation outcome among cannabis users revealed that respiratory-related were the second most common cause All-cause mortality was not significantly different between the two groups OR 0. There was no significant difference in the odds of respiratory-related ER visit or hospitalisation between cannabis users and control individuals, among both men and women table 4. However, compared with their respective controls, both men and women cannabis users had significantly higher and similar odds of all-cause ER visit or hospitalisation men: OR 1. Owing to the small sample size, we were unable to produce a reliable OR estimate for all-cause mortality for this sensitivity analysis and all others presented in table 4. In the subgroup of individuals who had not experienced a respiratory-related ER visit or hospitalisation in the year prior to the index date, no significant difference was observed in respiratory-related ER visit or hospitalisation odds among exposed versus control individuals table 4. However, significantly greater all-cause ER visit or hospitalisation odds were observed among cannabis users OR 1. In the subgroup of individuals who had experienced one or more respiratory-related ER visits or hospitalisations in the year prior to the index date, no significant differences were observed between the two groups with respect to any of the outcomes. Among never-tobacco smokers, there was no significant difference in respiratory-related ER visit or hospitalisation odds for exposed versus control individuals, but significantly greater all-cause ER visit or hospitalisation odds were observed among exposed OR 1. There was no significant difference in odds of respiratory-related ER visits or hospitalisations between cannabis users and control individuals in both the subgroup with pre-existing asthma and COPD and the subgroup without pre-existing asthma and COPD table 4. However, in both subgroups, cannabis use was associated with significantly elevated odds of all-cause ER visits or hospitalisations with pre-existing asthma or COPD: OR 1. Our primary outcome, odds of respiratory-related ER visits or hospitalisations, was not significantly greater among cannabis users than the the control group in either the overall cohort, or in any of our sensitivity analyses. However, our population-based study demonstrated that cannabis use was associated with significantly increased all-cause ER visits or hospitalisations, which is arguably an equally clinically important morbidity outcome, with a relatively low NNH of only 25, and that respiratory-related reasons were in fact the second most common aetiology for all-cause ER visits and hospitalisations among cannabis users. It is also possible that our analysis might have been insufficiently powered to detect a significant signal with respect to the primary outcome. Because our present research focus was on the possible association between cannabis use and acute respiratory infectious illness, it was beyond our scope to further describe possible associations between cannabis use and physical trauma. However, there is a growing body of published literature linking cannabis consumption to increased risks of generalised body injury, 37 motor vehicle accidents, 38 falls 39 and skeletal fractures along with low bone mineral density. Our study has several limitations. Causation should not be inferred as the explanation for any of our positive findings, given the observational nature of our study. Unmeasured confounding might have accounted for any of our observed positive results. While not all cannabis users in our exposed group might have consumed cannabis by inhalation which is the route that would be most likely to cause respiratory-related illness , inhalation is known to be the most common route of receipt. However, information on smoking is usually gathered by self-report. While the CCHS included a question that crudely captured frequency of cannabis use over the preceding year among exposed individuals, we were unable to perform a dose—response analysis, as reliable estimates could not be produced given small sample numbers in the frequency response categories. The high numbers of infrequent cannabis users in our exposed group might have contributed to our finding of no significant positive association between cannabis use and respiratory-related ER visits or hospitalisations. Information on quantity and potency of cannabis used was not collected by CCHS, and therefore, could not be accounted for in our analysis. We had access to cannabis use data only from the time prior to its decriminalisation in Canada ie, October Cannabis use has increased in Canada following its decriminalisation mostly among middle-aged and older adults , 41 potentially affecting both the frequency and nature of related adverse events, but we were unable to perform an analysis before and after decriminalisation. We were also unable to adjust for possible secondhand cannabis smoke exposure among control individuals, as such data were not available to us. Although we considered a broad range of ages in this study 12—65 years , our findings may not apply to children or older adults who use cannabis. Although our results are based on individuals from a single jurisdiction, Ontario, Canada, is culturally diverse. In conclusion, no significant association was observed between cannabis use and respiratory-related ER visits or hospitalisations. However, after adjusting for a broad range of covariates, the risk of an equally important morbidity outcome, all-cause ER visits or hospitalisation,s was significantly greater among cannabis users than among control individuals, and respiratory-related reasons were the second most common cause for ER visits and hospitalisations in the all-cause outcome. Further research is needed to confirm our findings, but our results suggest that cannabis use is associated with increased risk for serious adverse health events, and therefore, its recreational consumption in the general population should be discouraged. Cannabis use and risks of respiratory and all-cause morbidity and mortality: a population-based, data-linkage, cohort study Article options. Download PDF. Request permission. Article options. Cannabis use and risks of respiratory and all-cause morbidity and mortality: a population-based, data-linkage, cohort study. Abstract Introduction Although cannabis is frequently used worldwide, its impact on respiratory health is characterised by controversy. What is already known on this topic The published literature on cannabis smoking and acute respiratory illness is extremely limited, with one previous study demonstrating that cannabis smoking is associated with higher frequency of protracted acute bronchitis episodes, and another study showing significantly greater outpatient visits for respiratory illness, but not hospitalisations. What this study adds Our population-based, retrospective, propensity score matched cohort study, involving 15 individuals and extensive covariate adjustment, showed no significant difference in the frequency of respiratory-related emergency room visits or hospitalisations between cannabis users 3. Introduction Cannabis is the most commonly used psychoactive drug worldwide and its use is rising. Back to top. Methods Study design This was a retrospective, population-based cohort study, linking health survey data with multiple Ontario health administrative databases, for January 1, to December 31, Study population Ontario residents aged 12—65 years, who participated in either the — or — CCHS, were included. Exposed and control groups with index date definitions The exposed group consisted of individuals reporting any cannabis use in the preceding 12 months. Propensity score matching In order to minimise bias in our analysis from other variables, propensity score matching methods were used. Table 1 View inline View popup. Baseline characteristics of overall cohort, before and after propensity score matching. Sensitivity analyses Several planned sensitivity analyses were undertaken. Statistical analysis Descriptive statistics with standardised differences were calculated for all baseline covariates among exposed and control individuals, in order determine the adequacy of the matching process. Patient and public involvement statement Our study was conducted using deidentified data. Results Cohort derivation In the — and — CCHS, there were 35 individuals aged 12—65 years who had used cannabis in the past year or were control individuals. Overall cohort analysis In the propensity score matched cohort, odds of respiratory-related ER visit or hospitalisation was not significantly different between exposed and control individuals OR 0. Table 2 View inline View popup. ORs and confidence intervals for outcomes in the overall propensity score matched cohort. Table 3 View inline View popup. Breakdown of all-cause emergency room visit and hospitalisation outcome for cannabis users for the top ICD diagnostic codes recorded. Sensitivity analyses By sex There was no significant difference in the odds of respiratory-related ER visit or hospitalisation between cannabis users and control individuals, among both men and women table 4. Table 4 View inline View popup. ORs and confidence intervals for outcomes, according to selected subgroups. By prior respiratory-related ER visit or hospitalisation In the subgroup of individuals who had not experienced a respiratory-related ER visit or hospitalisation in the year prior to the index date, no significant difference was observed in respiratory-related ER visit or hospitalisation odds among exposed versus control individuals table 4. By pre-existing asthma or COPD There was no significant difference in odds of respiratory-related ER visits or hospitalisations between cannabis users and control individuals in both the subgroup with pre-existing asthma and COPD and the subgroup without pre-existing asthma and COPD table 4. Discussion Our primary outcome, odds of respiratory-related ER visits or hospitalisations, was not significantly greater among cannabis users than the the control group in either the overall cohort, or in any of our sensitivity analyses. Supplementary files. Publication history. 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Buying marijuana Lodz