Association of Social Determinants of Health with Tobacco Cessation Medication Prescriptions and Fills in a National Cohort of U.S. Veterans.

BACKGROUND

The Veterans Health Administration (VA) is committed to consistently addressing high rates of tobacco use among U.S. military veterans.

OBJECTIVE

This study examined the extent to which social determinants of health (SDOH) were associated with cessation medication prescriptions and fills.

DESIGN

A 12-month longitudinal retrospective design using VA EHR data.

PATIENTS: A cohort of 1,226,677 veterans using tobacco in fiscal year 2018.

MAIN MEASURES: Outcomes were prescriptions and fills for tobacco cessation medications (any medication or high-efficacy medication). Logistic regression models included SDOH predictors (age, sex, neighborhood deprivation [ND], housing insecurity, race/ethnicity, and service-connected disability [SCD]), adjusted for clinical covariates.

KEY

RESULTS

After adjusting for covariates, higher age (age 80 + OR = 0.23 [0.22-0.24]), higher ND (highest quartile OR = 0.97 [0.97-0.98]), and male sex (female sex OR = 1.06 [1.05-1.08]) were associated with lower odds of receiving any cessation prescription and a high-efficacy medication prescription. While some minoritized race/ethnicity was associated with lower prescription odds, African American race was associated with higher odds (OR = 1.06 [1.05-1.07]). However, odds of receiving a high-efficacy medication prescription were lower for African American veterans compared to the general population (OR = 0.74 [0.73-0.75]). SDOH that were associated with lower odds of prescription fills included older age (age 80 + OR = 0.67 [0.57-0.80]), White race (OR = 0.96 [0.95-0.98]), 0-50% SCD (OR = 0.93 [0.89-0.97]), and higher ND (highest quartile OR = 0.92 [0.89-0.96]). Younger age (age 35-40 OR = 1.10 [1.05-1.15]) and African American race (OR = 1.14 [1.09-1.18]) were associated with higher fill odds. Odds of filling a high-efficacy medication were lower for those with older age (age 80 + OR = 0.65 [0.48-0.88]) and African American race (OR = 0.89 [0.84-0.94]). White race (OR = 1.04 [1.02-1.06]) and female sex (OR = 1.16 [1.05-1.30]) were associated with higher odds of high-efficacy medication fills.

CONCLUSIONS

Given the VA's mission of serving all veterans consistently, findings showed that some groups of veterans may benefit from additional support for tobacco cessation pharmacotherapy.