Dr. Axe Wire · Study decoded · health

Vaping Linked to Arthritis Risk on Par With Smoking in 36,768 Adults

A new analysis finds vaping carries a joint-health risk similar to cigarettes, challenging the idea that it's a safer habit.

By Dr. Axe Editorial Team · October 28, 2026 · 1 source · Watch

Photo: Pexels

Vaping was linked to a higher rate of arthritis, at a level statistically similar to cigarette smoking, according to a study published October 23, 2026 in PLOS One.

36,768adults studied

2016–2022survey data

Researchers analyzed data on 36,768 U.S. adults ages 18 to 64 from the CDC's Behavioral Risk Factor Surveillance System, collected from 2016 to 2022, in a study published October 23, 2026 in PLOS One. Using a statistical method called double machine learning, designed to account for dozens of health and lifestyle factors at once, the team found that people who vaped had an arthritis rate 2.12 percentage points higher than non-vapers, while people who smoked had a rate 2.22 percentage points higher than non-smokers. When the model also accounted for using both, the estimates were 1.91 points for vaping and 2.14 for smoking. People who did both had a rate 2.33 percentage points higher than those who did neither. A statistical comparison found no meaningful difference between the vaping and smoking associations. Overall, 36.42% of the study group reported having arthritis, with obesity, out-of-pocket medical costs and lack of exercise emerging as the strongest predictors in the model.

Separate research cited in the paper has tied smoking to worse arthritis activity and reduced effectiveness of arthritis medications, and nicotine itself is a highly addictive compound regardless of delivery method. In general, nicotine exposure has been studied for effects on inflammation and bone turnover; this study did not test that mechanism directly, only the statistical association between habit and arthritis rate.

Arthritis Rate: Vapers and Smokers vs. Non-Users

PLOS One, 2026, Chike et al.

This is a cross-sectional survey analysis, not a controlled trial, so it shows a link, not proof that either habit causes arthritis. The paper's own economic cost estimates are illustrative scenarios rather than precise projections, and the design cannot rule out other unmeasured factors behind the association.

Dr. Axe’s Take

This data lines up with what I'd expect: vaping was never the safer habit it was marketed as. Nicotine itself is a driver of inflammation, and these numbers show vapers carrying a joint-health burden statistically indistinguishable from smokers. If you vape or smoke, I would not wait for more studies to make a change; talk with your doctor about a quit plan that fits your situation. In the meantime, I would lean on anti-inflammatory foods like fatty fish, ginger and leafy greens, and prioritize daily movement, since lack of exercise was one of the strongest predictors of arthritis in this analysis.

— Dr. Axe

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Study summary

Who: 36,768 U.S. adults ages 18–64 from the CDC's BRFSS survey, 2016–2022; 49.83% male, 36.42% reported arthritis.
Design: Observational, cross-sectional survey analysis using double machine learning to adjust for 27 covariates.
Dose: Exposure defined as current vaping (every day/some days) or smoking (100+ lifetime cigarettes or current).
Primary result: Vaping linked to a 2.12 percentage point higher arthritis rate; smoking linked to a 2.22 point higher rate (1.91 and 2.14 when accounting for both habits).
Secondary: Dual vaping and smoking linked to a 2.33 point higher rate; no statistically significant difference between vaping's and smoking's associations.
Funding / conflicts: Conflict statement in the PubMed record: The authors have declared that no competing interests exist. Funding not found in the part of the paper that was read.
Date: Oct 23, 2026