DURHAM, NC — Even though smoking is a risk factor for multiple sclerosis (MS) development, symptom burden, decreased medication efficacy and increased disease-related mortality, veterans with the disease continue to smoke at critically high rates, according to a new study.
Researchers from the Durham, NC, VAMC and colleagues pointed out that treatment rates and possible disparities are unknown. In response, to promote equitable treatment, they sought to investigate smoking cessation prescription practices for veterans with MS (VwMS) across social determinant factors.
To do that, the study team extracted data from the national VHA electronic health records between Oct. 1, 2017, and Sept. 30, 2018. VwMS who smoke were matched with veterans without MS who smoke on factors including age, race, depression and healthcare visits.
The results published in the journal Brain and Behavior indicated that the matched sample achieved a good balance across most covariates, compared to the pre-match sample.1
“VwMS (n = 3320) had decreased odds of receiving prescriptions for nicotine patches ([Odds Ratio]OR = 0.86, p < 0.01), non-patch nicotine replacement therapy (NRT; OR = 0.81, p < .001), and standard practice dual NRT (OR = 0.77, p < 0.01), compared to matches without MS (n = 13,280),” the authors reported. “Men with MS had lower odds of receiving prescriptions for nicotine patches (OR = 0.88, p = 0.05), non-patch NRT (OR = 0.77, p < 0.001), and dual NRT (OR = 0.72, p < 0.001). Similarly, Black VwMS had lower odds of receiving prescriptions for patches (OR = 0.62, p < 0.001), non-patch NRT (OR = 0.75, p < 0.05), and dual NRT (OR = 0.52, p < 0.01).”
On the other hand, the odds of receiving prescriptions for bupropion or varenicline did not differ between VwMS and matches without MS.
The researchers concluded, “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.”
They suggested their “foundational work will help inform future work to promote equitable treatment and implementation of cessation interventions for people living with MS.”
- Polick CS, Dennis P, Calhoun PS, Braley TJ, Lee E, Wilson S. Investigating disparities in smoking cessation treatment for veterans with multiple sclerosis: A national analysis. Brain Behav. 2024 May;14(5):e3513. doi: 10.1002/brb3.3513. PMID: 38698620; PMCID: PMC11066415.