Koma Jonathan W, Donohue Julie M, Barry Colleen L, Huskamp Haiden A, Jarlenski Marian
*University Honors College, University of Pittsburgh†Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD§Department of Health Care Policy, Harvard Medical School, Boston, MA.
Med Care. 2017 Dec;55(12):1023-1029. doi: 10.1097/MLR.0000000000000821.
Expanding Medicaid coverage to low-income adults may have increased smoking cessation through improved access to evidence-based treatments. Our study sought to determine if states' decisions to expand Medicaid increased recent smoking cessation.
Using pooled cross-sectional data from the Behavioral Risk Factor Surveillance Survey for the years 2011-2015, we examined the association between state Medicaid coverage and the probability of recent smoking cessation among low-income adults without dependent children who were current or former smokers (n=36,083). We used difference-in-differences estimation to examine the effects of Medicaid coverage on smoking cessation, comparing low-income adult smokers in states with Medicaid coverage to comparable adults in states without Medicaid coverage, with ages 18-64 years to those ages 65 years and above. Analyses were conducted for the full sample and stratified by sex.
Residence in a state with Medicaid coverage among low-income adult smokers ages 18-64 years was associated with an increase in recent smoking cessation of 2.1 percentage points (95% confidence interval, 0.25-3.9). In the comparison group of individuals ages 65 years and above, residence in a state with Medicaid coverage expansion was not associated with a change in recent smoking cessation (-0.1 percentage point, 95% confidence interval, -2.1 to 1.8). Similar increases in smoking cessation among those ages 18-64 years were estimated for females and males (1.9 and 2.2 percentage point, respectively).
Findings are consistent with the hypothesis that Medicaid coverage expansions may have increased smoking cessation among low-income adults without dependent children via greater access to preventive health care services, including evidence-based smoking cessation services.
将医疗补助覆盖范围扩大至低收入成年人可能通过改善获得循证治疗的机会而增加戒烟率。我们的研究旨在确定各州扩大医疗补助的决定是否增加了近期的戒烟率。
利用2011年至2015年行为危险因素监测调查的汇总横断面数据，我们研究了州医疗补助覆盖范围与近期戒烟概率之间的关联，这些数据来自没有受抚养子女的低收入成年人中的现吸烟者或曾经吸烟者（n = 36,083）。我们使用差分估计法来研究医疗补助覆盖范围对戒烟的影响，将有医疗补助覆盖的州的低收入成年吸烟者与没有医疗补助覆盖的州的类似成年人进行比较，年龄在18 - 64岁的人群与65岁及以上的人群进行比较。对全样本进行了分析，并按性别分层。
在18 - 64岁的低收入成年吸烟者中，居住在有医疗补助覆盖的州与近期戒烟率增加2.1个百分点相关（95%置信区间，0.25 - 3.9）。在65岁及以上的对照组中，居住在有医疗补助覆盖范围扩大的州与近期戒烟率的变化无关（-0.1个百分点，95%置信区间，-2.1至1.8）。18 - 64岁的女性和男性的戒烟率也有类似的增加（分别为1.9和2.2个百分点）。
研究结果与以下假设一致，即医疗补助覆盖范围的扩大可能通过增加获得预防性医疗服务（包括循证戒烟服务）的机会，从而提高了没有受抚养子女的低收入成年人的戒烟率。
