Young-Wolff Kelly C, Klebaner Daniella, Campbell Cynthia I, Weisner Constance, Satre Derek D, Adams Alyce S
*Division of Research, Kaiser Permanente Northern California, Oakland †Department of Psychiatry, University of California, San Francisco, CA.
Med Care. 2017 May;55(5):535-541. doi: 10.1097/MLR.0000000000000712.
To examine rates of smoking and tobacco treatment utilization by insurance coverage status (Medicaid, commercial, exchange) among newly enrolled patients in the post Affordable Care Act (ACA) era.
We examined new members who enrolled in Kaiser Permanente Northern California through Medicaid, the California exchange, or nonexchange commercial plans (N=122,298) in the first 6 months of 2014 following ACA implementation. We compared these groups on smoking prevalence and tested whether smokers in each group differed on sociodemographic characteristics and in their utilization of tobacco treatment (pharmacotherapy and counseling) in 2014.
Smoking prevalence was higher among Medicaid (22%) than exchange (13%) or commercial (12%) patients (P<0.0001). Controlling for key sociodemographic and clinical characteristics, Medicaid (odds ratio, 1.49; 95% confidence interval, 1.29-1.73) smokers had greater odds of tobacco treatment use than commercial smokers. Other groups at risk for underuse included men, younger patients, Asians, and Latinos.
In this cohort of newly enrolled patients after ACA implementation, Medicaid patients were more likely to be smokers compared with exchange and commercial patients, but they were also more likely to use tobacco treatment. Low tobacco treatment use among exchange and commercial plan smokers, as well as younger men, Asians and Latinos poses a significant obstacle to improving public health and additional targeted outreach strategies may be needed to engage these patients with available health services.
研究《平价医疗法案》（ACA）实施后新登记患者中按保险覆盖状态（医疗补助、商业保险、医保交易所保险）划分的吸烟率及烟草治疗利用情况。
我们对2014年ACA实施后的前6个月通过医疗补助、加利福尼亚医保交易所或非交易所商业保险计划加入北加利福尼亚凯撒医疗集团的新成员进行了研究（N = 122,298）。我们比较了这些组别的吸烟率，并测试了2014年每组吸烟者在社会人口统计学特征以及烟草治疗（药物治疗和咨询）利用方面是否存在差异。
医疗补助患者的吸烟率（22%）高于医保交易所患者（13%）或商业保险患者（12%）（P<0.0001）。在控制关键的社会人口统计学和临床特征后，医疗补助吸烟者（优势比，1.49；95%置信区间，1.29 - 1.73）使用烟草治疗的几率高于商业保险吸烟者。其他存在使用不足风险的群体包括男性、年轻患者、亚洲人和拉丁裔。
在ACA实施后的这组新登记患者中，与医保交易所患者和商业保险患者相比，医疗补助患者更有可能吸烟，但他们也更有可能使用烟草治疗。医保交易所和商业保险计划吸烟者以及年轻男性、亚洲人和拉丁裔的烟草治疗使用率较低，这对改善公众健康构成了重大障碍，可能需要额外的针对性外展策略，以使这些患者获得可用的医疗服务。
