调查多发性硬化症退伍军人戒烟治疗中的差异:国家分析
Carri S Polick1,2, Paul Dennis1,3, Patrick S Calhoun1,3
1Durham VA Health Care System, Durham, North Carolina, USA.
Brain and behavior
|May 3, 2024
概括
患有多发性硬化症 (MS) 的退伍军人接受的戒烟处方较少,特别是尼古丁替代疗法 (NRT). 处方差异在男性和黑人退伍军人中最为明显,突出了这一群体在护理方面的关键差距.
科学领域:
- 神经学 神经学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 吸烟是多发性硬化症 (MS) 发展,症状严重程度,治疗疗效降低和死亡率增加的重要危险因素.
- 患有MS的退伍军人 (VwMS) 呈现出不成比例的高吸烟率.
- 目前的戒烟治疗率和VwMS之间的潜在差异在很大程度上是未知的.
研究的目的:
- 调查退伍军人MS (VwMS) 戒烟药物治疗处方实践中的差异.
- 检查健康的社会决定因素如何影响吸烟戒烟治疗对VwMS的访问.
- 确定护理方面的差距,以促进对患有多发性硬化症的个人提供公平的戒烟支持.
主要方法:
- 使用国家退伍军人卫生管理局2017年10月1日至2018年9月30日的电子健康记录.
- 员工倾向得分与极端梯度增强机器学习模型相匹配,以比较吸烟的VwMS与匹配的对照 (没有MS吸烟的退伍军人).
- 进行了物流回归和按性别,种族和种族进行分层分析,以评估MS和戒烟药物治疗之间的关联.
主要成果:
- 与匹配的对照组相比,VwMS获得尼古丁贴片 (OR=0.86),非贴片尼古丁替代疗法 (NRT;OR=0.81) 和双重NRT (OR=0.77) 的处方几率明显较低.
- 与各自的对照组相比,男性和黑人VwMS的接受NRT处方的几率特别降低.
- 布普罗或瓦雷尼克林的处方率在VwMS和对照组之间没有显著差异.
结论:
- 吸烟者接受的戒烟治疗,包括标准护理双重NRT,较少,这表明医疗保健服务存在关键差距.
- 存在显著的差异,男性和黑人VwMS经历了较低的NRT处方率.
- 调查结果强调需要有针对性的干预措施,以确保所有患有多发性硬化症的人,特别是代表性不足的人口群体,均可获得戒烟支持.
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