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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References
Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. NCHS Data Brief: 1–8
Finkelstein EA, Trogdon JG, Cohen JW, Dietz W (2009) Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood) 28:w822–w831
Centers for Disease Control and Prevention (2018) The health effects of overweight and obesity. Heavy Weight, Department of Health and Human Services, Atlanta
US Bureau of Labor Statistics (2018) CPI inflation calculator. Databases, tables & calculators by subject. US Bureau of Labor Statistics, Washington, DC
American Society for Metabolic and Bariatric Surgery (2018) Who is a candidate for bariatric surgery?. American Society for Metabolic and Bariatric Surgery, Gainsville
Pentin PL, Nashelsky J (2005) What are the indications for bariatric surgery? J Fam Pract 54:633–634
Kaplan LM (2003) Body weight regulation and obesity. J Gastrointest Surg 7:443–451
Kokkinos A, Alexiadou K, Liaskos C, Argyrakopoulou G, Balla I, Tentolouris N, Moyssakis I, Katsilambros N, Vafiadis I, Alexandrou A, Diamantis T (2013) Improvement in cardiovascular indices after Roux-en-Y gastric bypass or sleeve gastrectomy for morbid obesity. Obes Surg 23:31–38
Weiner RA (2010) Indications and principles of metabolic surgery. Chirurg 81:379–394 quiz 395
Fuchs HF, Broderick RC, Harnsberger CR, Chang DC, Sandler BJ, Jacobsen GR, Horgan S (2015) Benefits of bariatric surgery do not reach obese men. J Laparoendosc Adv Surg Tech A 25:196–201
Young MT, Phelan MJ, Nguyen NT (2016) A decade analysis of trends and outcomes of male vs female patients who underwent bariatric surgery. J Am Coll Surg 222:226–231
Berger ER, Huffman KM, Fraker T, Petrick AT, Brethauer SA, Hall BL, Ko CY, Morton JM (2018) Prevalence and risk factors for bariatric surgery readmissions: findings from 130,007 admissions in the metabolic and bariatric surgery accreditation and quality improvement program. Ann Surg 267:122–131
Mainous AG 3rd, Johnson SP, Saxena SK, Wright RU (2013) Inpatient bariatric surgery among eligible black and white men and women in the United States, 1999–2010. Am J Gastroenterol 108:1218–1223
US Department of Health and Human Services Office of Minority Health (2017) Obesity and African Americans. US Department of Health and Human Services, Rockville
United States Renal Data System (2016) 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda
United States Renal Data System (2018) 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda
Jannah N, Hild J, Gallagher C, Dietz W (2018) Coverage for obesity prevention and treatment services: analysis of medicaid and state employee health insurance programs. Obesity (Silver Spring) 26:1834–1840
US Centers for Medicare and Medicaid Services (2006) Decision Memo for Bariatric Surgery for the Treatement of Morbid Obesity (CAG-00250R). In: US Centers for Medicare and Medicaid Services (ed) US Centers for Medicare and Medicaid Services, Baltimore
Becker C (2019) Health reform and health mandates for obesity. National Conference for State Legislatures, Denver
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (Published January 2017) User Guide for the 2015 Participant Use Data File (PUF)
Department of Health and Human Services Office for Human Research Protections (2018) 45 CFR 46-Protection of Human Subjects, 2018 Requirements: 104 Exempt research. Department of Health and Human Services Office for Human Research Protections, Rockville
National Center for Health Statistics (2014) National Health and Nutrition Examination Survey, NHANES 2013–2014. Centers for Disease Control and Prevention, Atlanta
United States Census Bureau (2015) 2015 American Community Survey
Wood MH, Carlin AM, Ghaferi AA, Varban OA, Hawasli A, Bonham AJ, Birkmeyer NJ, Finks JF (2019) Association of race with bariatric surgery outcomes. JAMA Surg 154:e190029
Sheka AC, Kizy S, Wirth K, Grams J, Leslie D, Ikramuddin S (2018) Racial disparities in perioperative outcomes after bariatric surgery. Surg Obes Relat Dis 15:786–793
Moore D, Cooper C, Davis-Smith YM (2016) African American obese mens’ attitudes and perceptions of bariatric surgery: a phenomenological study. Spectrum 4:43–60
Griffith DM, Ober Allen J, Gunter K (2011) Social and cultural factors influence African American men’s medical help seeking. Res Soc Work Pract 21:337–347
Kutner M, Greenberg E, Jin Y, Paulsen C (2006) The Health Literacy of America’s Adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006–483). US Department of Education. National Center for Education Statistics, Washington, DC
The Henry J, Foundation Kaiser Family (2018) Men’s health disparities. State Health Facts, San Francisco
Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW, Hirsh HK, Wright LA, Bronsert M, Karimkhani E, Magid DJ, Havranek EP (2013) Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med 11:43–52
FitzGerald C, Hurst S (2017) Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 18:19
Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, Eng E, Day SH, Coyne-Beasley T (2015) Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health 105:e60–e76
van Ryn M, Burgess D, Malat J, Griffin J (2006) Physicians’ perceptions of patients’ social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease. Am J Public Health 96:351–357
Wee CC, Huskey KW, Bolcic-Jankovic D, Colten ME, Davis RB, Hamel M (2014) Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med 29:68–75
Long SK, Bart L (2017) Patients feel comfortable talking to providers about sensitive issues, but providers dont often ask. Health Reform Monitoring Survey, Urban Institute Health Policy Center, Washington DC
Ward SH, Gray AM, Paranjape A (2009) African Americans’ perceptions of physician attempts to address obesity in the primary care setting. J Gen Intern Med 24:579–584
Jackson CL, Redline S, Kawachi I, Williams MA, Hu FB (2013) Racial disparities in short sleep duration by occupation and industry. Am J Epidemiol 178:1442–1451
Dimick J, Ruhter J, Sarrazin MV, Birkmeyer JD (2013) Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions. Health Aff (Millwood) 32:1046–1053
Pirson M, Dehanne F, Van den Bulcke J, Leclercq P, Martins D, De Wever A (2018) Evaluation of cost and length of stay, linked to complications associated with major surgical procedures. Acta Clin Belg 73:40–49
Tevis SE, Kennedy GD (2013) Postoperative complications and implications on patient-centered outcomes. J Surg Res 181:106–113
Acknowledgements
The authors would like to thank Monami Majumder and the Patient Voices Network of Buffalo, NY for their help in preparing this manuscript.
Funding
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.
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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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Hoffman, A.B., Myneni, A.A., Orom, H. et al. Disparity in access to bariatric surgery among African-American men. Surg Endosc 34, 2630–2637 (2020). https://doi.org/10.1007/s00464-019-07034-z
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DOI: https://doi.org/10.1007/s00464-019-07034-z