Longitudinal Impact of Tobacco Use and Social Determinants on Respiratory Health Disparities Among Louisiana Medicaid Enrollees

Abstract: Tobacco use remains a leading preventable contributor to serious health conditions in the United States, notably chronic obstructive pulmonary disease (COPD) and severe COVID-19 complications. Within Louisiana's Medicaid population, tobacco use prevalence is particularly high compared to privately insured groups, yet its full impact on long-term outcomes is not fully understood. This study aimed to investigate how tobacco use, in conjunction with demographic and clinical risk factors, influences the incidence of COPD and COVID-19 among Medicaid enrollees over time. We analyzed Louisiana Department of Health data from January 2020 to February 2023. Chi-square tests were conducted to provide descriptive statistics, and multivariate logistic regression models were applied across three discrete waves to assess both cross-sectional and longitudinal associations between risk factors and disease outcomes. Enrollees without baseline diagnoses of COPD or COVID-19 were followed to determine new-onset cases in subsequent waves. Adjusted odds ratios (AOR) were calculated after controlling for socio-demographic variables, comorbidities, and healthcare utilization patterns. Tobacco use emerged as a significant independent predictor of both COPD (Adjusted Odd Ratio= 1.12) and COVID-19 (Adjusted Odd Ratio = 1.66). Additional risk factors -- such as older age, gender, region, and pre-existing health conditions -- also showed significant associations with higher incidence rates of COPD and COVID-19. By linking tobacco use, demographic disparities, and comorbidities to an increased risk of COPD and COVID-19, this study underscores the urgent need for targeted tobacco cessation efforts and prevention strategies within this underserved population.