Katia Noyes, PhD, MPH1, Monami Majumdar, MPH2, Ajay A Myneni, MBBS, PhD, MPH2, Heather Orom, PhD3, Steven D Schwaitzberg, MD2, Aaron B Hoffman, MD, FACS2. 1Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 2Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
INTRODUCTION: This study examines the differences in access to bariatric and metabolic surgery (BMS) among gender and racial subgroups to develop patient-centered, culturally appropriate and cost-effective interventions to overcome barriers to care. Technological advances have transformed BMS into a safe and highly effective procedure for dramatic weight loss and lowering burden of obesity-related disorders (type 2 diabetes, cardiovascular and renal diseases). African American patients are at greater risk for early onset of these comorbidities and greater disease severity. Across all races, men are far less likely to undergo BMS compared to women.
METHODS AND PROCEDURES: We utilized the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry database, which has a comprehensive collection of pre-, peri- and post-operative factors on patients who underwent BMS (n = 165,424). We tested the differences in receipt of BMS, comorbidities and complications between the racial and gender subgroups using chi-square tests and used logistic regression to conduct multivariate analyses.
RESULTS: Our study sample consisted of 74.9% Whites and 16.7% African Americans. White women were most likely to undergo BMS (58.7%) followed by White men (16.2%), African American women (14.4%) and African American men (2.2%). A closer examination of the patient characteristics among men revealed that despite being younger, African American men (mean age of 44.1 years compared to 47.8 years among White men, P <0.01) were more likely to have a history of hypertension (P <0.01), renal insufficiency (P <0.01), required dialysis (P <0.01) and had a higher ASA score (P <0.01). Furthermore, they were more likely to stay in the hospital for more than 4 days after BMS [odds ratio (OR) = 1.47, 95% confidence interval (CI): 1.21–1.78), and to suffer from post-operative complications (OR = 1.29, 95% CI: 1.02-1.64).
CONCLUSIONS: African American men are at significant disadvantage in accessing BMS compared to White men and African American women, despite being eligible both on the grounds of BMI and related comorbidity. Further research is necessary to understand and address individual, provider-level, and societal barriers to BMS among African American men. Further, it may be prudent to refer African American men for BMS at a much younger age compared to White men, as it may reduce the prevalence and severity of obesity-related disorders and post-operative complications as well as lessen the financial burden in this population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95499
Program Number: S167
Presentation Session: Disparities
Presentation Type: Podium