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18.03.2020 | Original Contributions | Ausgabe 7/2020 Open Access

Obesity Surgery 7/2020

Ethnic Disparities in Use of Bariatric Surgery in the USA: the Experience of Native Americans

Obesity Surgery > Ausgabe 7/2020
Ibrahim Al-Sumaih, Nga Nguyen, Michael Donnelly, Brian Johnston, Zhamak Khorgami, Ciaran O’Neill
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11695-020-04529-w) contains supplementary material, which is available to authorized users.

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To examine disparities in use of bariatric surgery in the USA with particular focus on the experience of Native Americans.

Materials and Methods

Multivariable logistic regression models were applied to the hospital discharge HCUP-NIS dataset (2008–2016) in order to examine the influence of ethnicity in use of bariatric surgery while controlling for aspects of need, predisposing and enabling factors. Separate models investigated disparities in length of stay, cost and discharge to healthcare facility among patient episodes for bariatric surgery.


Full data for 1,729,245 bariatric surgery eligible participants were extracted from HCUP-NIS. The odds of Native Americans receiving bariatric surgery compared to White Americans were 0.67 (95% CI, 0.62–0.73) in a model unadjusted for covariates; 0.65 (95% CI, 0.59–0.71) in a model adjusted for demography and insurance; 0.59 (95% CI, 0.54–0.64) in a model adjusted for clinical variables; and 0.72 (95% CI, 0.66–0.79) in a model adjusted for demographic, insurance types and clinical variables. Native Americans who underwent surgery had significantly shorter lengths of stay, lower healthcare expenditures and lower likelihood of discharge to other healthcare facilities relative to White Americans (controlling for covariates).


Our study, the first study to examine this subject, showed apparent variations in receipt of bariatric surgery between Native Americans and White Americans even after a range of covariates were controlled. In addition, Native Americans have shorter lengths of stay and significantly lower expenditures.

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