Jerry T Dang, MD1, Noah Switzer, MPH, MD1, Samuel Skulsky, BSc1, Bailey Miskew Nichols, BSc1, Xinzhe Shi, MPH2, Shey Eagle Bear1, Chris de Gara, MBBS1, Daniel W Birch, MSc, MD1, Shahzeer Karmali, MPH, MD1. 1University of Alberta, 2Centre for the Advancement of Minimally Invasive Surgery
INTRODUCTION: The objective of this study is to determine socioeconomic factors that influence access to bariatric treatment and surgery in a publicly-funded healthcare program with a focus on Indigenous populations. Rates of obesity are markedly higher among Indigenous persons, estimated to be 37.8%, compared to 22.6% for non-Indigenous persons. Similarly, rates of diabetes are twice as high among Indigenous Canadians relative to the general population and disease onset frequently occurs at a lower body mass index (BMI) and younger age. In obese patients who are refractory to diet and exercise, bariatric surgery is a viable option, with demonstrated efficacy in sustained weight reduction and in many patients, hyperglycemic remission. The utilization of bariatric surgery in Indigenous populations has not been well documented, however in one study out of the United States, only 0.46% of bariatric surgery was performed on Indigenous patients. An understanding of the socioeconomic drivers underlying this disparity may enable physicians to identify at risk individuals, who may benefit from bariatric treatment.
METHODS: A retrospective review of prospectively collected data was performed on all severely obese patients (BMI ≥ 35) discharged from the Edmonton Adult Bariatric Specialty Clinic in 2016. Socioeconomic data include gender, marital status, education, occupation, smoking status, alcohol use, estimated income and Indigenous status. Multivariate logistic regression analysis was performed to determine socioeconomic factors that predict completion of bariatric surgery.
RESULTS: Seven-hundred-and-eighty patients met inclusion criteria, of which 0.9% were identified as Indigenous (n = 7). Of the Indigenous cohort, all were unemployed, 71.4% were single, 57.1% had completed secondary education and 28.6% had completed college. None of these patients completed bariatric surgery. Due to low numbers, multivariate analysis was not completed for this cohort.
For the whole cohort, 28.8% of patients successfully completed bariatric surgery. The main reasons for not completing the bariatric program were poor attendance (32.7%) and patient decision not to pursue surgery (22.0%). In multivariate analysis, patients who were married (OR 2.04, 95%CI 1.2-3.5), non-smokers (OR 0.30, 95%CI 0.14-0.65), and female (OR 0.33, 95%CI 0.19-0.56) were more likely to complete bariatric surgery. Education, income, and occupation were not predictive of completion.
CONCLUSIONS: Despite an alarming rate of obesity and diabetes in Indigenous populations, very few Indigenous people are treated in specialized bariatric treatment centers. Further, major socioeconomic factors did not influence successful completion of bariatric surgery. Especially in a public healthcare system, more treatment should be directed at underserved Indigenous populations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88421
Program Number: P649
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster