BACKGROUND: Health insurance coverage is associated with reduced smoking prevalence in the U.S. However, the extent to which this association differs by race/ethnicity is unknown. The goals of this study were to estimate smoking prevalence among U.S. adults (18+ years old) by private or Medicare insurance and investigate racial/ethnic differences by coverage type.
METHODS: We merged data (n=38,081, N= 204,606,674) from the Tobacco Use Supplement (January and May 2019) and the 2019 Annual Social and Economic Supplement of the Current Population Survey. We assessed associations between each insurance type (private, Medicare) and smoking prevalence within non-Hispanic (NH) White, NH Black/African American (BAA), NH American Indian/Alaska Native (AIAN) and Hispanic adults using Rao-Scott chi–square tests. We used a logistic regression model (for the odds of smoking) with two interactions: between private coverage and race/ethnicity (NH White, BAA and Hispanic), and between Medicare coverage and race/ethnicity. The model controlled for sociodemographic factors, disability status, Medicaid coverage and several other factors.
RESULTS: Both private and Medicare coverage (compared to no such coverage) were associated with lower smoking prevalence within each racial/ethnic group. However, only a few results were statistically significant: private coverage was associated with significantly lower prevalence among NH White (8.8% vs. 19.6%, p<0.001) and BAA (9.3% vs. 19.6%, p<0.001) adults, and Medicare coverage was associated with significantly lower prevalence among NH White adults (9.6% versus 12.3%, p=0.002). In the model, the interaction between private coverage and race/ethnicity was significant (p=0.044): private coverage was significantly associated with lower prevalence among NH White adults only (AOR=0.59, 98.3%CI=0.48:0.73). The other interaction was not significant.
CONCLUSIONS: The association between private coverage and smoking prevalence differs by race/ethnicity, and type of coverage is associated with lower prevalence among NH White adults only. The study points to possible underutilization of private coverage to enable smoking cessation among communities of color.