Disparity in access to bariatric surgery among African-American men
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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.
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.
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.
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.
KeywordsBariatric surgery Obesity Disparities Men African-American men Postsurgical outcomes
The authors would like to thank Monami Majumder and the Patient Voices Network of Buffalo, NY for their help in preparing this manuscript.
This manuscript was in part funded by University at Buffalo Surgical Outcomes and Research (UB SOAR) program at the Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
Compliance with ethical standards
Dr. Hoffman is a paid consultant for Ethicon US, LLC (not related to the study). Dr. Steven Schwaitzberg is a paid consultant for Nu View Surgical, Acuity Bio, Activ Surgical, Human Extensions, Levitra Magnetics, and Arch Therapeutics (not related to the study). Drs. Myneni, Orom, and Noyes do not have any conflicts of interest or financial ties to disclose. The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and the centers participating in the ACS MBSAQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
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