Soulakova Julia N, Crockett Lisa J
Department of Population Health Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, USA.
Department of Psychology, University of Nebraska-Lincoln, 315 Burnett Hall, Lincoln, NE 68588, USA.
Healthcare (Basel). 2023 Nov 21;11(23):3014. doi: 10.3390/healthcare11233014.
The goal of this study was to assess the joint role of race/ethnicity and a health insurance coverage type (private, Medicare, Medicaid) in current cigarette use among adults in the U.S. Data from the 2019 Tobacco Use Supplement and the 2019 Annual Social and Economic Supplement of the Current Population Survey were merged (n = 39,882). Bivariate associations between each coverage type and smoking prevalence were examined within each of six racial/ethnic groups. A multiple logistic regression model (for the odds of current cigarette use) was estimated to explore the interactions between race/ethnicity and an indicator of each type of coverage among Hispanic, non-Hispanic (NH) Black/African American, and NH White adults. All analyses included survey weights. Results of bivariate analyses indicated that private and Medicare coverage were associated with significantly lower smoking prevalence (compared to no such coverage), while Medicaid coverage was associated with significantly higher smoking prevalence (all ≤ 0.05). Some of these associations were significant among NH Black/African American and NH White adults (all ≤ 0.05). The model indicated that the interaction between race/ethnicity and the indicator of private coverage was significant ( = 0.044): private coverage was significantly associated with lower prevalence among NH White adults only (AOR = 0.59, 98.3%, CI = 0.46:0.76). In addition, Medicaid coverage was significantly associated with higher smoking prevalence (overall). The study points to possible racial/ethnic disparities in the quality of smoking-related health care that people with the same type of coverage receive and possible underutilization of health care services even among adults with health insurance coverage, especially among communities of color and Medicaid enrollees.
本研究的目的是评估种族/族裔与医疗保险覆盖类型（私人保险、医疗保险、医疗补助）在美国成年人当前吸烟行为中的联合作用。将2019年烟草使用补充调查数据与2019年当前人口调查年度社会和经济补充调查数据合并（n = 39,882）。在六个种族/族裔群体中的每一个群体内部，研究了每种保险覆盖类型与吸烟率之间的双变量关联。估计了一个多元逻辑回归模型（用于当前吸烟的几率），以探讨西班牙裔、非西班牙裔（NH）黑人/非裔美国人和NH白人成年人中种族/族裔与每种保险覆盖类型指标之间的相互作用。所有分析都纳入了调查权重。双变量分析结果表明，私人保险和医疗保险覆盖与显著较低的吸烟率相关（与无此类保险相比），而医疗补助覆盖与显著较高的吸烟率相关（所有P≤0.05）。其中一些关联在NH黑人/非裔美国人和NH白人成年人中具有显著性（所有P≤0.05）。该模型表明，种族/族裔与私人保险指标之间的相互作用具有显著性（P = 0.044）：私人保险仅与NH白人成年人中较低的患病率显著相关（调整后比值比[AOR]=0.59，98.3%置信区间[CI]=0.46:0.76）。此外，医疗补助覆盖总体上与较高的吸烟率显著相关。该研究指出，即使在有医疗保险覆盖的成年人中，尤其是在有色人种社区和医疗补助参保者中，具有相同保险类型的人在吸烟相关医疗保健质量方面可能存在种族/族裔差异，并且可能存在医疗服务利用不足的情况。
