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

Article · October 2010with22 Reads
DOI: 10.1007/s11695-009-0054-x · Source: PubMed
Abstract
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.
    • Due to inconsistency in the categorization of socioeconomic status (SES) across studies, we were unable to aggregate SES data (SupplementaryTable 3 ). Eligible patients who had surgery were more likely to have high household incomes [15, 17, 31, 37] . In terms of interaction effects, an inverse relationship was found between rates of bariatric surgery and socioeconomic status among White patients, while a positive relationship between rates of surgery and socioeconomic status was documented for Blacks [29] .
    [Show abstract] [Hide abstract] ABSTRACT: This systematic review explores the sociodemographic factors associated with the utilization of bariatric surgery among eligible patients. Electronic databases were searched for population-based studies that explored the relationship between sociodemographic characteristics of patients eligible for bariatric surgery to those who actually received the procedure. Twelve retrospective cohort studies were retrieved, of which the results of 9 studies were pooled using a random effects model. Patients who received bariatric surgery were significantly more likely to be white versus non-white (OR 1.54; 95 % CI 1.08, 2.19), female versus male (OR 2.80; 95 % CI 2.46, 3.22), and have private versus government or public insurance (OR 2.51; 95 % CI 1.04, 6.05). Prospective cohort studies are warranted to further determine the relative effect of these factors, adjusting for confounding factors.
    Full-text · Article · Mar 2015
    • Bariatric surgery utilization has increased throughout the US, but rates are still lower in ethnic minority populations despite the relatively high prevalence of obesity in these groups [10, 11]. In general, our study supports the results of previous studies which suggest that lower utilization of bariatric surgery among persons who are socially disadvantaged [4]. In a recent survey of more than 330 primary care patients, Wee and colleagues found that physicians are less likely to recommend surgery to minority patients even though these patients are as likely as Caucasian patients to seriously consider undergoing bariatric surgery if recommended by their physician [9].
    [Show abstract] [Hide abstract] ABSTRACT: Ethnic minority adults have disproportionately higher rates of obesity than Caucasians but are less likely to undergo bariatric surgery. Recent data suggest that minorities might be less likely to seek surgery. Whether minorities who seek surgery are also less likely to proceed with surgery is unclear. We interviewed 651 patients who sought bariatric surgery at two academic medical centers to examine whether ethnic minorities are less likely to proceed with surgery than Caucasians and whether minorities who do proceed with surgery have higher illness burden than their counterparts. We collected patient demographics and abstracted clinical data from the medical records. We then conducted multivariable analyses to examine the association between race and the likelihood of proceeding with bariatric surgery within 1 year of initial interview and to compare the illness burden by race and ethnicity among those who underwent surgery. Of our study sample, 66 % were Caucasian, 18 % were African-American, and 12 % were Hispanics. After adjustment for socioeconomic factors, there were no racial differences in who proceeded with bariatric surgery. Among those who proceeded with surgery, illness burden was comparable between minorities and Caucasian patients with the exception that African-Americans were underrepresented among those with reflux disease (0.4, 95 % CI 0.2-0.7) and depression (0.4, 0.2-0.7), and overrepresented among those with anemia (4.8, 2.4-9.6) than Caucasian patients. Race and ethnicity were not independently associated with likelihood of proceeding with bariatric surgery. Minorities who proceeded with surgery did not clearly have higher illness burden than Caucasian patients.
    Full-text · Article · Dec 2014
    • While bariatric surgery has been demonstrated to be an effective treatment for obesity, it appears that access to, and uptake of bariatric surgery does not uniformly match with populations with high rates of obesity and obesity-related diseases232425 . Factors such as ethnicity , age, sex, socioeconomic status, geographic location and others appear to play an important role in determining access to care.
    [Show abstract] [Hide abstract] 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.http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013004920.
    Full-text · Article · Feb 2014
    • 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.
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Nov 2010
  • [Show abstract] [Hide abstract] ABSTRACT: Not Available
    Conference Paper · Sep 1997 · Surgery for Obesity and Related Diseases
  • [Show abstract] [Hide abstract] ABSTRACT: Not Available
    Conference Paper · Sep 1997 · Surgery for Obesity and Related Diseases
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