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Examining Racial/Ethnic Disparities in Tobacco Dependence Treatment Among Medicaid Beneficiaries Using Fifty State Medicaid Claims, 2009–2014

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Abstract

In the USA, low-income racial/ethnic minority groups experience higher smoking rates and greater smoking-related disease burden than their White counterparts. Despite the adverse effects, racial/ethnic minorities are less likely to access tobacco dependence treatment (TDT). Medicaid is one of the largest payers of TDT in the USA and covers predominantly low-income populations. The extent of TDT use among beneficiaries from distinct racial/ethnic groups is unknown. The objective is to estimate racial/ethnic differences in TDT use among Medicaid fee-for-service beneficiaries. Using a retrospective study design and 50 state (including the District of Columbia) Medicaid claims (2009–2014), we employed multivariable logistic regression models and predictive margin methods to estimate TDT use rates among adults (18–64) enrolled (≥ 11 months) in Medicaid fee-for-service programs (January 2009–December 2014) by race/ethnicity. The population included White (n = 6,536,004), Black (n = 3,352,983), Latinx (n = 2,264,647), Asian (n = 451,448), and Native American/Alaskan Native (n = 206,472) beneficiaries. Dichotomous outcomes reflected service use in the past year. Any TDT use was operationalized as any smoking cessation medication fill, any smoking cessation counseling visit, or any smoking cessation outpatient visit. In secondary analyses, we disaggregated TDT use into three separate outcomes. Results suggested that Black (10.6%; 95% CI = 9.9–11.4%), Latinx (9.5%; 95% CI = 8.9–10.2%), Asian (3.7%; 95% CI = 3.4–4.1%), and Native American/Alaskan Native (13.7%; 95% CI = 12.7–14.7%) beneficiaries had lower TDT use rates compared to White beneficiaries (20.6%). Similar racial/ethnic treatment disparities were identified across all outcomes. By identifying significant racial/ethnic disparities in TDT use between 2009 and 2014, this study provides a benchmark against which to measure recent interventions in state Medicaid programs improving equity in smoking cessation interventions.

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Funding

This project was supported by the National Cancer Institute R01CA229355 (PI Cook).

Author information

Authors and Affiliations

  1. Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA

    Michael William Flores, Brian Mullin, Amanda Sharp, Anika Kumar, Margo Moyer & Benjamin Lê Cook

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Michael William Flores & Benjamin Lê Cook

  3. Center for Mindfulness & Compassion, Cambridge Health Alliance, Cambridge, MA, USA

    Amanda Sharp

  4. Heller School of Social Policy, Brandies University, Waltham, MA, USA

    Anika Kumar

Authors
  1. Michael William Flores
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  5. Margo Moyer
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  6. Benjamin Lê Cook
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Contributions

All authors made substantial contributions to the study conception and design. Benjamin Lê Cook acquired the data and Brian Mullin analyzed the data. All authors aided in data interpretation. All authors contributed to manuscript drafting and revised it critically for important intellectual content. All authors read and approved the final manuscript. All authors agree to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Michael William Flores.

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Ethics Approval

This study was approved by the Institutional Review Board at Cambridge Health Alliance.

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Appendix

Appendix

Adjusted estimates of racial/ethnic differences in any TDT use among Medicaid fee-for-services beneficiaries, 2009–2014

 

Estimate

95% confidence limits

P-value

Race/ethnicity (reference White)

  American Indian/Alaskan Native

 − 0.4939

 − 0.5279

 − 0.4599

 < 0.0001

  Asian/Pacific Islander

 − 1.9029

 − 1.9475

 − 1.8582

 < 0.0001

  Black

 − 0.7833

 − 0.7937

 − 0.7728

 < 0.0001

  Latinx

 − 0.9018

 − 0.9152

 − 0.8884

 < 0.0001

Age (reference 55–64)

  18–24

 − 0.9261

 − 0.9432

 − 0.9089

 < 0.0001

  25–34

 − 0.4014

 − 0.4163

 − 0.3865

 < 0.0001

  35–44

 − 0.0124

 − 0.0262

0.0015

0.0809

  45–54

0.2030

0.1905

0.2154

 < 0.0001

Sex

  Female

 − 0.0256

 − 0.0342

 − 0.0169

 < 0.0001

Chronic conditions (reference no.)

  Arthritis

0.4286

0.4179

0.4393

 < 0.0001

  Asthma

0.5830

0.5715

0.5944

 < 0.0001

  Breast cancer

0.3356

0.3024

0.3688

 < 0.0001

  Colorectal cancer

0.0195

 − 0.0399

0.0789

0.5201

  COPD

0.6883

0.6773

0.6992

 < 0.0001

  Diabetes

0.1817

0.1693

0.1942

 < 0.0001

  Endometrial cancer

 − 0.0605

 − 0.1642

0.0433

0.2532

  Hyperlipidemia

0.3835

0.3730

0.3940

 < 0.0001

  Hypertension

0.3070

0.2964

0.3176

 < 0.0001

  Ischemic

0.0574

0.0421

0.0727

 < 0.0001

  Lung cancer

0.3367

0.2898

0.3835

 < 0.0001

  Prostate cancer

0.0582

 − 0.0279

0.1443

0.1852

  Stroke

 − 0.0133

 − 0.0349

0.0082

0.2240

  TDT coverage

0.0926

0.0892

0.0961

 < 0.0001

Year (reference 2009)

  2010

 − 0.1391

 − 0.1483

 − 0.1299

 < 0.0001

  2011

 − 0.1396

 − 0.1493

 − 0.1299

 < 0.0001

  2012

 − 0.0991

 − 0.1088

 − 0.0893

 < 0.0001

  2013

 − 0.1153

 − 0.1252

 − 0.1054

 < 0.0001

  2014

 − 0.1032

 − 0.1162

 − 0.0954

 < 0.0001

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Flores, M.W., Mullin, B., Sharp, A. et al. Examining Racial/Ethnic Disparities in Tobacco Dependence Treatment Among Medicaid Beneficiaries Using Fifty State Medicaid Claims, 2009–2014. J. Racial and Ethnic Health Disparities 11, 755–763 (2024). https://doi.org/10.1007/s40615-023-01558-w

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