National Trends in Cessation Counseling, Prescription Medication Use, and Associated Costs Among US Adult Cigarette Smokers
National Trends in Cessation Counseling, Prescription Medication Use, and Associated Costs Among US Adult Cigarette Smokers
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DOI：
10.1001/jamanetworkopen.2019.4585
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发表时间：
2019-05-01
影响因子：
13.8
通讯作者：
Michos, Erin D.
中科院分区：
文献类型：
--
作者：
Tibuakuu, Martin;Okunrintemi, Victor;Michos, Erin D.
重要性 吸烟是美国可预防疾病和死亡的主要原因。当单独或组合使用时，戒烟咨询和戒烟药物与戒烟率的增加有关。 目的 呈现美国全国范围内具有代表性的活跃成年吸烟者样本中自我报告的接受医生戒烟建议和使用处方戒烟药物的趋势以及相关支出。 设计、设置和参与者 这项针对 18 岁或以上美国成年人的重复横断面研究于 7 月 5 日开始进行， 2018年至2018年8月15日。数据收集于2006年1月1日至2015年12月31日期间，来自医疗支出小组调查，这是美国对个人和家庭、医疗保健人员和雇主进行的年度调查。参与者（n = 29 106）是从上一年全国健康访谈调查的受访者中随机抽取的非机构化平民。使用多变量逻辑回归模型来检查社会人口因素与接受医生戒烟建议和使用戒烟处方药物之间的关联。使用两部分计量经济学模型来评估医疗保健支出。 主要结果和措施 自我报告接受医生戒烟建议和服用处方戒烟药物的趋势，以及相关的总支出和自付费用。 结果 研究样本由 29 106 名参与者组成，平均 (SD) 年龄为 57 (10) 岁，其中包括 13 670 名女性(47.0%)。对结果进行加权，以提供对 3120 万活跃成年吸烟者的估计。报告接受医生建议戒烟的吸烟者比例从 2006 年至 2007 年的 60.2%（95% CI，58.5%-62.0%）增加到 2014 年至 2015 年的 64.9%（95% CI，62.8%-66.9%），趋势 P = 0.001。女性接受医生戒烟建议的几率在统计学上显着较高（比值比 [OR]，1.50；95% CI，1.39-1.59），而未投保参与者则较低（OR，0.58；95% CI，0.52-0.65）。总体而言，处方戒烟药物的使用量下降，总支出也相应减少，从 2006 年至 2007 年的 1.46 亿美元（自付费用 4600 万美元）减少到 2014 年至 2015 年的 7300 万美元（自付费用 900 万美元）。 男性（比值比 [OR]，0.78；95% CI，0.66-0.91），无保险（OR，0.58；95% CI，0.41-0.83）和少数种族/族裔（非裔美国人：OR，0.51 [95% CI，0.38-0.69]；亚洲人：OR，0.31 [95% CI，0.10-0.93]；西班牙裔：OR，0.53 [95% CI， 0.36-0.78]) 参与者使用处方戒烟药物的可能性较小。 结论和相关性尽管美国吸烟率一直很低，但男性、年轻人、无保险个人、种族/族裔少数群体以及没有吸烟相关合并症的人中，医生提供戒烟建议的比例较低，已知处方戒烟药物的使用率较低，可能与这些亚组中较高的吸烟率有关；这一发现要求更有针对性地实施戒烟指南。
IMPORTANCE Cigarette smoking is the leading cause of preventable disease and death in the United States. When used separately or in combination, smoking cessation counseling and cessation medications have been associated with increased cessation rates.OBJECTIVES To present trends in self-reported receipt of physician advice to quit smoking and in use of prescription smoking cessation medication along with their associated expenditures among a nationally representative sample of active adult smokers in the United States.DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study of US adults aged 18 years or older was conducted from July 5, 2018, through August 15, 2018. Data were collected between January 1, 2006, and December 31, 2015, from the Medical Expenditure Panel Survey, an annual US survey of individuals and families, health care personnel, and employers. Participants (n = 29 106) were noninstitutionalized civilians who were randomly drawn from the respondents of the previous year's National Health Interview Survey. Multivariable logistic regression models were used to examine the associations between sociodemographic factors and receipt of physician cessation advice and use of cessation prescription medication. A 2-part econometric model was used to assess health care expenditures.MAIN OUTCOMES AND MEASURES Trends in self-reported receipt of physician advice to quit and uptake of prescription smoking cessation medications with associated total and out-of-pocket expenditures.RESULTS The study sample consisted of 29 106 participants, with a mean (SD) age of 57 (10) years and a composition of 13 670 women (47.0%). The results were weighted to provide estimates for 31.2 million active adult cigarette smokers. The proportion of smokers who reported receiving physician advice to quit increased from 60.2%(95% CI, 58.5%-62.0%) in 2006 to 2007 to 64.9% (95% CI, 62.8%-66.9%) in 2014 to 2015, with a P for trend = .001. The odds of receiving physician cessation advice was statistically significantly higher in women (odds ratio [OR], 1.50; 95% CI, 1.39-1.59) and lower among uninsured participants (OR, 0.58; 95% CI, 0.52-0.65). Overall, prescription smoking cessation medication use decreased with a corresponding reduction in total expenditures from $146 million (out-of-pocket cost, $46 million) in 2006 to 2007 to $73 million (outof- pocket cost, $9 million) in 2014 to 2015. Male (odds ratio [OR], 0.78; 95% CI, 0.66-0.91), uninsured (OR, 0.58; 95% CI, 0.41-0.83), and racial/ethnic minority (African American: OR, 0.51 [95% CI, 0.38-0.69]; Asian: OR, 0.31 [95% CI, 0.10-0.93]; Hispanic: OR, 0.53 [95% CI, 0.36-0.78]) participants were less likely to use prescription smoking cessation medications.CONCLUSIONS AND RELEVANCE The lower rates of delivery of physician advice to quit smoking and the lower uptake of known prescription smoking cessation medications among men, younger adults, uninsured individuals, racial/ethnic minority groups, and those without smoking-associated comorbidities may be associated with the higher smoking rates among these subgroups despite an all-time low prevalence of smoking in the United States; this finding calls for a more targeted implementation of smoking cessation guidelines.