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

Objective: Tobacco use remains a leading preventable cause of severe health conditions, notably chronic obstructive pulmonary disease (COPD) and severe COVID-19 complications. Tobacco prevalence is particularly high among Louisiana Medicaid enrollees compared to privately insured individuals; yet, its full long-term impact remains unclear. We aimed to examine how tobacco use, alongside demographic and clinical factors, influences COPD and COVID-19 incidence among Medicaid participants over time. Methods: Using Louisiana Department of Health data (January 2020-February 2023), we performed chi-square tests and multivariate logistic regression models across three study waves, assessing associations between risk factors and new disease cases. We calculated adjusted odds ratios (AORs) after controlling for demographics, comorbidities, and healthcare utilization. Results: Tobacco use significantly predicted new COPD (AOR = 1.12, 95% CI = 1.05-1.18) and COVID-19 cases (AOR = 1.66, 95% CI = 1.15-2.38). Other key predictors included older age, sex, region, and existing comorbidities, each of which was all significantly associated with increased disease incidence. Conclusions: By clearly linking tobacco use, demographic disparities, and clinical conditions to heightened COPD and COVID-19 risks, we highlight an urgent need for tailored tobacco cessation and prevention initiatives in Louisiana’s underserved Medicaid population.