Polick Carri S, Dennis Paul, Calhoun Patrick S, Braley Tiffany J, Lee Eunice, Wilson Sarah
Durham VA Health Care System, Durham, North Carolina, USA.
School of Nursing, Duke University, Durham, North Carolina, USA.
Brain Behav. 2024 May;14(5):e3513. doi: 10.1002/brb3.3513.
Smoking is a risk factor for multiple sclerosis (MS) development, symptom burden, decreased medication efficacy, and increased disease-related mortality. Veterans with MS (VwMS) smoke at critically high rates; however, treatment rates and possible disparities are unknown. To promote equitable treatment, we aim to investigate smoking cessation prescription practices for VwMS across social determinant factors.
We extracted data from the national Veterans Health Administration electronic health records between October 1, 2017, and September 30, 2018. To derive marginal estimates of the association of MS with receipt of smoking-cessation pharmacotherapy, we used propensity score matching through the extreme gradient boosting machine learning model. VwMS who smoke were matched with veterans without MS who smoke on factors including age, race, depression, and healthcare visits. To assess the marginal association of MS with different cessation treatments, we used logistic regression and conducted stratified analyses by sex, race, and ethnicity.
The matched sample achieved a good balance across most covariates, compared to the pre-match sample. VwMS (n = 3320) had decreased odds of receiving prescriptions for nicotine patches ([Odds Ratio]OR = 0.86, p < .01), non-patch nicotine replacement therapy (NRT; OR = 0.81, p < .001), and standard practice dual NRT (OR = 0.77, p < .01), compared to matches without MS (n = 13,280). Men with MS had lower odds of receiving prescriptions for nicotine patches (OR = 0.88, p = .05), non-patch NRT (OR = 0.77, p < .001), and dual NRT (OR = 0.72, p < .001). Similarly, Black VwMS had lower odds of receiving prescriptions for patches (OR = 0.62, p < .001), non-patch NRT (OR = 0.75, p < .05), and dual NRT (OR = 0.52, p < .01). The odds of receiving prescriptions for bupropion or varenicline did not differ between VwMS and matches without MS.
VwMS received significantly less smoking cessation treatment, compared to matched controls without MS, showing a critical gap in health services as VwMS are not receiving dual NRT as the standard of care. Prescription rates were especially lower for male and Black VwMS, suggesting that under-represented demographic groups outside of the white female category, most often considered as the "traditional MS" group, could be under-treated regarding smoking cessation support. This foundational work will help inform future work to promote equitable treatment and implementation of cessation interventions for people living with MS.
吸烟是多发性硬化症（MS）发病、症状负担加重、药物疗效降低及疾病相关死亡率增加的危险因素。患有MS的退伍军人（VwMS）吸烟率极高；然而，治疗率及可能存在的差异尚不清楚。为促进公平治疗，我们旨在调查不同社会决定因素下VwMS的戒烟处方情况。
我们从2017年10月1日至2018年9月30日的国家退伍军人健康管理局电子健康记录中提取数据。为得出MS与接受戒烟药物治疗之间关联的边际估计值，我们通过极端梯度提升机器学习模型使用倾向得分匹配法。吸烟的VwMS与吸烟的非MS退伍军人在年龄、种族、抑郁及医疗就诊等因素上进行匹配。为评估MS与不同戒烟治疗的边际关联，我们使用逻辑回归，并按性别、种族和民族进行分层分析。
与匹配前样本相比，匹配样本在大多数协变量上实现了良好的平衡。与非MS匹配对象（n = 13280）相比，VwMS（n = 3320）接受尼古丁贴片处方的几率降低（比值比[OR]=0.86，p <.01），接受非贴片尼古丁替代疗法（NRT；OR = 0.81，p <.001）及标准联合NRT的几率降低（OR = 0.77，p <.01）。患有MS的男性接受尼古丁贴片处方的几率较低（OR = 0.88，p =.05），接受非贴片NRT的几率较低（OR = 0.77，p <.001），接受联合NRT的几率较低（OR = 0.72，p <.001）。同样，黑人VwMS接受贴片处方的几率较低（OR = 0.62，p <.001），接受非贴片NRT的几率较低（OR = 0.75，p <.05），接受联合NRT的几率较低（OR = 0.52，p <.01）。VwMS与非MS匹配对象接受安非他酮或伐尼克兰处方的几率无差异。
与无MS的匹配对照相比，VwMS接受的戒烟治疗显著更少，这表明卫生服务存在重大差距，因为VwMS未接受作为标准治疗的联合NRT。男性和黑人VwMS的处方率尤其较低，这表明除了常被视为“传统MS”群体的白人女性之外，其他代表性不足的人群在戒烟支持方面可能未得到充分治疗。这项基础工作将有助于为未来促进MS患者公平治疗及实施戒烟干预措施的工作提供信息。
