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.

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