Background: Disadvantaged neighborhood socioeconomic status (SES) is associated with increased cardiovascular risk, including smoking. We hypothesized that neighborhood SES is also associated with smoking cessation assistance (counseling or pharmacotherapy). We analyzed the association between lower neighborhood SES and cessation assistance rates in the NCDR PINNACLE registry.
Methods: Among 332582 current smokers seen between 1/1/2013 and 12/31/2016 in 348 PINNACLE cardiology practices, we determined the rates of cessation assistance. We then extracted lower neighborhood SES variables using the American Community Survey data (Table 1). Using multivariable hierarchical logistic regression models, we assessed the association between the SES variables and cessation assistance provision. We also measured the practice variation in cessation assistance, using a median rate ratio (MRR, table footnote).
Results: Cessation assistance was provided to 115279 (35%) smokers. Higher rates of English proficiency and higher rates of public health insurance (vs. private insurance) were associated with higher odds of smoking cessation assistance (Table 1). In contrast, higher median household income and higher rates of high school graduates were associated with lower odds of smoking cessation assistance. The median practice-level rate of cessation assistance was 24% (interquartile range 5% - 52%). A large practice-level variability in smoking cessation assistance existed (MRR: 6.16, 95% CI 5.38 - 6.95), even after adjustment for patient and neighborhood characteristics.
Conclusions: Contrary to our hypothesis, we found that most measures of lower neighborhood socioeconomic status were associated with higher rates of smoking cessation assistance. Our findings suggest that social determinants of health affect preventative efforts and additional research is needed to explore the reasons behind this association and its impact on health outcomes.