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See further details on this 2023 study here

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There are studies showing lung biopsies in these patients showing emphysema-like changes, even though they never smoked a single cigarette. While e-cigarette liquid can share some chemicals that have been determined to be safe such as in-food preservatives, Shah warns that the stomach can process and digest more substances than the lungs and that vaping may change the safe nature of those products

The reason may be that the distribution density of e-cigarette POS in developed cities such as Shanghai is much higher than in other cities and rural areas, which increases the environmental exposure to e-cigarettes and promotes the purchase and use of e-cigarettes 19