Association between Emergency Department utilization by Kentucky Medicaid patients and smoke-free ordinances

Several Kentucky communities have passed smoke-free ordinances since 2000. The purpose of this study is to determine if the rate of Emergency Department (ED) visits for smoking-related respiratory and cardiovascular health events changed after the passage of a community smoke-free ordinance in children and adults enrolled in Medicaid. Using Medicaid claims data, rates of ED visits within counties from before and after the passage of a smoke-free ordinance were calculated from patients that had a primary or secondary diagnosis of asthma, bronchitis, emphysema, MI, or stroke. The study design is a retrospective analysis, where treatment counties are defined as a county that has passed an ordinance and control counties are defined as a county that has not passed an ordinance. A regression model was used to analyze the data and control for the strength of the policy, demographic factors, differences in region, and the time periods between the passages of ordinances. It was found that counties with strong ordinances had lower ED rates for adults with asthma than counties with no ordinances or weak ordinances (p=0.010) and counties with strong (p<0.001) and weak (p=0.001) ordinances had lower ED rates for MI. The results of this study demonstrate some of the health effects of smoke-free ordinances on Kentucky Medicaid beneficiaries, which is a vulnerable population that faces health disparities. The implementation of smoke-free ordinances has been controversial in many Kentucky communities and the findings from this interdisciplinary project could have implications for future policy changes.