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Another study using an air-liquid interface (ALI) to assess the cytotoxic effects on human bronchial epithelial cells, showed that IQOS exposure induced higher cytotoxicity (reduced metabolic activity) than e-cigarettes or air controls but lower than combustible cigarettes 22

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This approach enabled the partitioning of the overall change in burden into these key components, providing clearer insights into how demographic and epidemiological transitions shaped trends over time