Hooks-Anderson Denise R, Salas Joanne, Secrest Scott, Skiöld-Hanlin Sarah, Scherrer Jeffrey F
Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO, USA.
Fam Pract. 2018 Mar 27;35(2):160-165. doi: 10.1093/fampra/cmx099.
Previous evidence of race disparities in smoking cessation treatment has been limited to mostly survey studies which increase the potential for recall bias. We examined if African American versus white patients in primary care are less likely to receive any treatment or if race disparities are specific to the type of treatment offered using data pulled from a large electronic health record system.
Medical record data from 3510 white and 2707 African American patients were available from primary care encounters between 2008 and 2015 and was used to define smoking status, cessation treatments (counselling and medication), and covariates. The association between race and type of smoking cessation treatment offered was measured by logistic regression models before and after adjusting for covariates.
Smoking cessation counselling was offered to 9.3% of African American and 7.8% of white patients, and a prescription for smoking cessation medication was offered to 12.3% of African American and 16.4% of white patients. After adjusting for covariates in logistic regression models, whites were significantly less likely than African American patients to receive smoking cessation counselling [odds ratio (OR) = 0.81; 95% confidence interval (CI) = 0.65-0.99] and were significantly more likely to receive a prescription for a smoking cessation medication (OR = 1.23; 95% CI = 1.03-1.47).
Less than 20% of smokers received any type of therapy to assist in smoking cessation. We observed a race disparity in type of smoking cessation therapy provided to white and African American primary care patients. Further research is needed to increase treatment rates and eliminate disparities.
以往关于戒烟治疗中种族差异的证据大多局限于调查研究，这增加了回忆偏倚的可能性。我们使用从一个大型电子健康记录系统中提取的数据，研究了初级保健中的非裔美国患者与白人患者相比，接受任何治疗的可能性是否更低，或者种族差异是否特定于所提供的治疗类型。
从2008年至2015年的初级保健就诊记录中获取了3510名白人患者和2707名非裔美国患者的病历数据，用于确定吸烟状况、戒烟治疗（咨询和药物治疗）以及协变量。在调整协变量前后，通过逻辑回归模型测量种族与所提供的戒烟治疗类型之间的关联。
9.3%的非裔美国患者和7.8%的白人患者接受了戒烟咨询，12.3%的非裔美国患者和16.4%的白人患者获得了戒烟药物处方。在逻辑回归模型中调整协变量后，白人患者接受戒烟咨询的可能性显著低于非裔美国患者[优势比（OR）=0.81；95%置信区间（CI）=0.65-0.99]，而获得戒烟药物处方的可能性显著高于非裔美国患者（OR = 1.23；95% CI = 1.03-1.47）。
不到20%的吸烟者接受了任何类型的戒烟治疗。我们观察到在为白人和非裔美国初级保健患者提供的戒烟治疗类型上存在种族差异。需要进一步研究以提高治疗率并消除差异。
