Faculty of Health and Environmental Sciences, AUT University, 90 Akoranga Drive, Northcote, Auckland, New Zealand.
University of Auckland (UoA), Auckland, New Zealand.
Obes Surg. 2018 Aug;28(8):2500-2507. doi: 10.1007/s11695-018-3195-y.
Factors such as ethnicity, gender, and socioeconomic status may play a role in both access to and attrition from bariatric programs before surgery is undertaken. New Zealand (NZ) has high rates of obesity in its Pacific population and the indigenous Māori. These groups also experience poorer health outcomes and therefore have the greatest need for surgery.
A retrospective cross-sectional study of 704 people referred for and accepted onto a publicly funded bariatric surgery from 2007 to 2016. The demographic and clinical features of two groups were compared: those that completed surgery successfully (n = 326) and those that dropped out of the program before surgery (n = 378). We also attempted to identify factors associated with attrition.
The attrition rate was high (54%), with a significant difference according to gender (men 66% vs 45% women, p < 0.001) and ethnicity (39% in NZ Europeans, 50% in Māori, and 73% in Pacific patients, p < 0.001). Two out of three European women proceeded to surgery, but fewer than one in seven Pacific men. Attrition was associated with having a higher mean BMI and being a smoker. Logistic regression modeling showed that while employment seemed to be protective against attrition for NZ Europeans (p < 0.004), it was not for Pacific patients.
While there was no obvious bias in rates of referral, there is clearly a need for better ways to support Māori and Pacific people, and men in particular, to complete bariatric surgery. Further research is needed to clarify the socio-economic and cultural barriers that underlie this phenomenon.
在接受手术之前，种族、性别和社会经济地位等因素可能会影响进入和退出减肥计划的情况。新西兰（NZ）的太平洋人口和土着毛利人肥胖率很高。这些群体的健康状况也较差，因此最需要手术。
这是一项回顾性的横断面研究，共纳入了 704 名于 2007 年至 2016 年期间被转诊并接受公共资助减肥手术的患者。比较了两组患者的人口统计学和临床特征：成功完成手术的组（n=326）和在手术前退出计划的组（n=378）。我们还试图确定与流失相关的因素。
流失率很高（54%），性别差异显著（男性 66%，女性 45%，p<0.001），种族差异也显著（新西兰欧洲人 39%，毛利人 50%，太平洋患者 73%，p<0.001）。三分之二的欧洲女性继续进行了手术，但只有不到七分之一的太平洋男性继续进行了手术。流失与较高的平均 BMI 和吸烟有关。逻辑回归模型显示，虽然就业似乎对新西兰欧洲人的流失有保护作用（p<0.004），但对太平洋患者没有影响。
尽管转诊率没有明显的偏见，但显然需要更好的方法来支持毛利人和太平洋人，特别是男性，以完成减肥手术。需要进一步研究来阐明导致这种现象的社会经济和文化障碍。
