台湾不同社会经济群体腹腔镜减肥手术的使用情况及疗效的基于人群的分析。

A population-based analysis of use and outcomes of laparoscopic bariatric surgery across socioeconomic groups in Taiwan.

作者信息

Huang Chun-Che, Huang Yu-Tung, Chiu Chong-Chi

机构信息

Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.

Master Degree Program in Aging and Long-Term Care, College of Nursing, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, Taiwan.

出版信息

Int J Equity Health. 2015 Nov 11;14:127. doi: 10.1186/s12939-015-0265-9.

DOI:10.1186/s12939-015-0265-9

PMID:26558509

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4642632/

Abstract

BACKGROUND

With the growing development of minimally invasive techniques for the treatment of morbid obesity, laparoscopic bariatric surgery (LBS) is increasingly performed. This study aimed to assess the association between patients' socioeconomic status (SES) and the likelihood of undergoing LBS and related outcomes in Taiwan.

METHODS

This nationwide population-based study was conducted by using data from Taiwan's National Health Insurance Research Database. A total of 3678 morbidly obese patients aged 18 years and older who underwent conventional open bariatric surgery or LBS were identified between 2004 and 2011. Regression analyses were performed using generalized estimating equation (GEE) models to account for the nesting of patients within physician to assess patients' SES category associated with the use of LBS and related outcomes. Odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated.

RESULTS

Compared with those with medium and low SES (84.6 % and 80.2 %), patients with high SES (88.1 %) had the highest percentage of undergoing LBS (P < 0.001). After adjusting for patient demographics, institution and surgeon characteristics, the multivariate GEE analysis revealed that the highest likelihood of undergoing LBS was noted in morbidly obese patients with high SES (OR = 1.45, 95 % CI 1.10-1.90), followed by those with medium SES (OR = 1.27, 95 % CI 1.04-1.56). In addition, patients with high SES had slightly lower length of hospital stay (LOS; OR = 0.90, 95 % CI 0.82-0.99) and hospital treatment cost (OR = 0.93, 95 % CI 0.87-0.99) than their counterparts after adjustment.

CONCLUSIONS

The increased likelihood of undergoing LBS and lower LOS and hospital treatment cost were noted among morbidly obese patients with higher SES. This finding suggests there is the need to improve clinical practice and reduce health disparities in the surgical treatment of morbidly obese patients.

摘要

背景

随着治疗病态肥胖的微创技术不断发展，腹腔镜减肥手术（LBS）的开展越来越多。本研究旨在评估台湾患者的社会经济地位（SES）与接受LBS的可能性及相关结局之间的关联。

方法

本基于全国人群的研究利用了台湾国民健康保险研究数据库的数据。2004年至2011年间，共识别出3678例18岁及以上接受传统开放性减肥手术或LBS的病态肥胖患者。使用广义估计方程（GEE）模型进行回归分析，以考虑患者在医生内的嵌套情况，从而评估与LBS使用及相关结局相关的患者SES类别。估计比值比（OR）和95%置信区间（CI）。

结果

与中低SES患者（分别为84.6%和80.2%）相比，高SES患者接受LBS的比例最高（88.1%，P<0.001）。在调整患者人口统计学、机构和外科医生特征后，多变量GEE分析显示，高SES的病态肥胖患者接受LBS的可能性最高（OR = 1.45，95%CI 1.10 - 1.90），其次是中SES患者（OR = 1.27，95%CI 1.04 - 1.56）。此外，调整后，高SES患者的住院时间（LOS；OR = 0.90，95%CI 0.82 - 0.99）和住院治疗费用（OR = 0.93，95%CI 0.87 - 0.99）略低于其对应患者。