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05.08.2019 | 2019 SAGES Oral | Ausgabe 6/2020

Surgical Endoscopy 6/2020

Disparity in access to bariatric surgery among African-American men

Zeitschrift:
Surgical Endoscopy > Ausgabe 6/2020
Autoren:
A. B. Hoffman, A. A. Myneni, H. Orom, S. D. Schwaitzberg, K. Noyes
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00464-019-07034-z) contains supplementary material, which is available to authorized users.
The earlier version of the study was presented at the 2019 SAGES Annual Meeting.

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Abstract

Background

Despite improvements in safety and effectiveness in surgical management of extreme obesity, men and racial minorities are less likely to receive metabolic and bariatric surgery (MBS) compared to other patient groups. This study examines the racial and gender disparities in access to MBS to understand the mechanism that drives these problems and to propose strategies for closing the disparity gap.

Methods

Using 2013–2014 National Health and Nutrition Examination Survey data, we estimated the proportion of individuals, by race and gender, who were eligible for MBS based on Body Mass Index (BMI) and comorbidity profile. We analyzed the 2015 MBS Accreditation and Quality Improvement Program Participant Use Data File to examine differences in patient characteristics, comorbidities, and postsurgical outcomes among African-American (AA) and White men. Predictors of poor outcomes were identified using unconditional logistic regression models.

Results

AA men represented 11% of eligible patients but only 2.4% of actual MBS patients. Compared to White men, AA men were younger, had higher BMI, were more likely to have a history of hypertension, renal insufficiency, required dialysis, and had American Society of Anesthesiologists class 4 or 5 (all P values < 0.01). After surgery, AA men were more likely to suffer from postoperative complications (adjusted odds ratio (aOR) 1.25, 95% confidence interval (CI) 1.02–1.52) and stayed in the hospital for more than 4 days (aOR 1.51, 95% CI 1.26–1.82) compared to White men.

Conclusions

Despite being eligible for MBS based on both BMI and obesity-related comorbidities, AA men are significantly less likely to undergo MBS. Those AA men who receive surgery are significantly younger than White men but also experience greater comorbidities compared to White men and all women. Further longitudinal studies into patient-, system-, and provider-level barriers are necessary to understand and address these disparities.

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