Racial, Socioeconomic, and Rural-Urban Disparities in Obesity-Related Bariatric Surgery

Veterans Rural Health Resource Center-Eastern Region, VAMC (11Q), WRJ, VT 05009, USA.
Obesity Surgery (Impact Factor: 3.75). 10/2010; 20(10):1354-60. DOI: 10.1007/s11695-009-0054-x
Source: PubMed


Morbid obesity is associated with serious health and social consequences, high medical costs and is increasing in the USA, particularly among rural, socioeconomically disadvantaged populations. Bariatric surgery more often provides significant long-term weight loss than traditional weight loss treatments. We examined the likelihood of bariatric surgery among morbidly obese patients across rural/urban locales, racial/ethnic groups, insurance categories, socioeconomic, and comorbidity levels.
We examined 159,116 records representing 774,000 patients with morbid obesity from the 2006 Nationwide Inpatient Sample. We determined the likelihood, expressed in odds ratios, of bariatric surgery associated with each patient characteristic using survey-weighted univariate logistic regression. We also performed multivariate logistic regression, assuming all patient factors were independent.
After adjusting for patient-level characteristics, the most rural residents were 23% less likely to receive bariatric surgery than urban residents. Other demographic features associated with significantly lower odds ratios for bariatric surgery included minority status, male gender, lower income, older age, non-private insurance status, and higher comorbidity. Rural-dwelling patients who are non-white, male, poorer, older, sicker, and non-privately insured almost never received bariatric surgery (OR = 0.0089).
Though obesity is more prevalent among middle-aged, rural, economically disadvantaged, and racial/ethnic minority populations, these patients are unlikely to access bariatric surgery. Because obesity is a leading cause of preventable morbidity and mortality in the USA, effective treatments should be made available to all patients who might benefit. Current Medicare/Medicaid policies that reimburse only high volume centers may effectively deny rural residents who rely on these insurance programs for bariatric surgery.

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    • "Health inequity, defined as unfair inequalities in population groups that lead to unequal chances to access health care services [22], may be to blame. Studies have documented significant disparities between the general morbidly obese population and the subset that have access to and/or receive bariatric surgical procedures [23-25]. Compared to the general population, individuals who fulfill the NIH criteria, and therefore are candidates for bariatric surgery, are often older, come from racial or ethnic minorities, are economically disadvantaged, and have low levels of education [23,26]. "
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    ABSTRACT: Bariatric surgery is the only weight-loss treatment available that results in both sustained weight loss and improvements of obesity-related comorbidities. Individuals who meet the eligibility criteria for bariatric surgery are generally older, come from racial or ethnic minorities, are economically disadvantaged, and have low levels of education. However, the population who actually receives bariatric surgery does not reflect the individuals who need it the most. The objective is to conduct a systematic review of the literature exploring the inequities to the access of bariatric surgery. EMBASE and Medline databases will be searched for observational studies that compared at least one of the PROGRESS-PLUS sociodemographic characteristics of patients eligible for bariatric surgery to those who actually received the procedure. Articles published in the year 1980 to present with no language restrictions will be included. For inclusion, studies must only include adults (>=18 years old) who meet National Institutes of Health (NIH) eligibility criteria for bariatric surgery defined as having either (1) a body mass index (BMI) of 40 kg/m2 or greater; or (2) BMI of 35 kg/m2 or greater with significant weight-related comorbidities. Eligible interventions will include malabsorptive, restrictive, and mixed bariatric procedures. There appears to be inequities in access to bariatric surgery. In order to resolve the health inequity in the treatment of obesity, a synthesis of the literature is needed to explore and identify barriers to accessing bariatric surgery. It is anticipated that the results from this systematic review will have important implications for advancing solutions to minimize inequities in the utilization of bariatric surgery.
    Systematic Reviews 02/2014; 3(1):15. DOI:10.1186/2046-4053-3-15
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    • "However, such gender differences have not been found within large samples of morbidly obese individuals seeking treatment [29]. Although the rates of morbid obesity are roughly equivalent among men and women, women are 4 times more likely than men to undergo weight loss surgery [30]. Thus, the men who do present for evaluation for weight loss surgery might be experiencing greater distress and be more severely medically or psychiatrically compro- mised. "
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    ABSTRACT: Preoperative bariatric psychological evaluations often use both a clinical interview and psychometric testing. Given concerns regarding the psychometric properties of some measures, the present study explored the internal consistency reliability and validity of the Symptom Checklist 90 Revised (SCL-90-R) and has provided a preliminary set of norms for the instrument within a bariatric population. Although the American Society for Metabolic and Bariatric Surgery has included the SCL-90-R as a suggested measure for the assessment of personality and psychopathology, no known studies have reported on the reliability or validity of the SCL-90-R within bariatric samples. The present study was completed at a large Midwestern medical center in the United States. SCL-90-R inventories were completed by 322 preoperative bariatric patients as a part of their psychological evaluation. Most patients were women (75.5%), with a mean age of 46.7 ± 10.8 years and a mean body mass index of 50.4 ± 10.9 kg/m(2). The internal consistency coefficients for the 9 subscales were .76-.90. Convergent validity was demonstrated by scale correlations with the data gathered in the clinical interview. Compared with other recently studied measures, including the Millon Behavioral Medicine Diagnostic, the SCL-90-R demonstrated good internal consistency and preliminary validity data for bariatric patients. Providers might want to consider the SCL-90-R as a screening measure for bariatric surgery patients.
    Surgery for Obesity and Related Diseases 11/2010; 6(6):622-7. DOI:10.1016/j.soard.2010.02.039 · 4.07 Impact Factor
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