Association of social determinants of health with tobacco cessation medication prescriptions and fills in a national cohort of U.S. Veterans

Abstract: Background: The Veterans Health Administration (VA) is committed to consistently addressing high rates of tobacco use among U.S. military veterans. Objective: This study examined the extent to which social determinants of health (SDOH) were associated with cessation medication prescriptions and fills. Design: A 12-month longitudinal retrospective design using VA EHR data. Patients: A cohort of 1,226,677 veterans using tobacco in fiscal year 2018. Main Measures: Outcomes were prescriptions and fills for tobacco cessation medications (any medication or high-efficacy medication). Logistic regression models included SDOH predictors (age, sex, neighborhood deprivation [ND], housing insecurity, race/ethnicity, and service-connected disability [SCD]), adjusted for clinical covariates. Key Results: After adjusting for covariates, higher age (age 80+OR=0.23 [0.22–0.24]), higher ND (highest quartile OR=0.97 [0.97–0.98]), and male sex (female sex OR=1.06 [1.05–1.08]) were associated with lower odds of receiving any cessation prescription and a high-efficacy medication prescription. While some minoritized race/ethnicity was associated with lower prescription odds, African American race was associated with higher odds (OR=1.06 [1.05–1.07]). However, odds of receiving a high-efficacy medication prescription were lower for African American veterans compared to the general population (OR=0.74 [0.73–0.75]). SDOH that were associated with lower odds of prescription fills included older age (age 80+OR=0.67 [0.57–0.80]), White race (OR=0.96 [0.95–0.98]), 0–50% SCD (OR=0.93 [0.89–0.97]), and higher ND (highest quartile OR=0.92 [0.89–0.96]). Younger age (age 35–40 OR=1.10 [1.05–1.15]) and African American race (OR=1.14 [1.09–1.18]) were associated with higher fill odds. Odds of filling a high-efficacy medication were lower for those with older age (age 80+OR=0.65 [0.48–0.88]) and African American race (OR=0.89 [0.84–0.94]). White race (OR=1.04 [1.02–1.06]) and female sex (OR=1.16 [1.05–1.30]) were associated with higher odds of high-efficacy medication fills. Conclusions: Given the VA’s mission of serving all veterans consistently, findings showed that some groups of veterans may benefit from additional support for tobacco cessation pharmacotherapy.