Division of General Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
Division of General Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Surg Obes Relat Dis. 2019 Aug;15(8):1340-1347. doi: 10.1016/j.soard.2019.05.035. Epub 2019 Jun 4.
In 2013, 18% of Canadian adults had obesity (body mass index [BMI] >30 kg/m), compared with 25.7% of Canada's Indigenous population. Bariatric surgery is an effective treatment for obesity, but has not been studied in Canadian Indigenous populations.
To determine the effects of bariatric surgery in the Indigenous Ontario population.
Multicenter data from the publicly funded Ontario bariatric program and registry.
Prospectively collected data using all surgical patients between March 2010 and 2018 was included in initial analysis and included the following postoperative outcomes: diabetes, hypertension, and gastroesophageal reflux disease. Demographic characteristics, baseline characteristics, and univariate outcomes were assessed using Pearson Χ or t tests. Multivariable regression for BMI change was used with complete case analysis and multiple imputation.
Of 16,629 individuals initially identified, 338 self-identified as Indigenous, 13,502 as Non-Indigenous, and 2789 omitted ethnicity and were excluded. Baseline demographic characteristics were not statistically different; rates of hypertension (P = .03) and diabetes (P < .001) were higher in the Indigenous population. Univariable analysis showed similar 1-year BMI change (Indigenous: 15.8 ± 6.0 kg/m; Non-Indigenous: 16.1 ± 5.6 kg/m, P = .362). After adjustment, BMI change was not different between groups at 6 months (effect size = .07, 95% confidence interval -.45 to .58, P = .803) and 1 year (effect size = -.24, 95% confidence interval -.93 to .45, P = .489). Rates of co-morbidities were similar at 1 year between the 2 populations, despite differences at baseline. Six-month and 1-year follow-up rates were higher in the Non-Indigenous population (P < .001, P = .005, respectively).
Weight loss and resolution of obesity-related co-morbidities are similar in Indigenous and Non-Indigenous patients. Access to surgery, patient selection, and long-term results merit further investigation.
2013 年，加拿大成年人中有 18%的人肥胖（体重指数[BMI]＞30kg/m），而加拿大原住民的这一比例为 25.7%。减重手术是肥胖症的有效治疗方法，但尚未在加拿大原住民人群中进行研究。
确定减重手术在安大略省原住民人群中的效果。
来自公共资助的安大略省减重计划和登记处的多中心数据。
初始分析纳入了 2010 年 3 月至 2018 年期间所有接受手术的患者前瞻性收集的数据，包括以下术后结果：糖尿病、高血压和胃食管反流病。使用 Pearson Χ或 t 检验评估人口统计学特征、基线特征和单变量结果。使用完全案例分析和多重插补进行 BMI 变化的多变量回归。
在最初确定的 16629 人中，有 338 人自我认定为原住民，13502 人自我认定为非原住民，2789 人省略了种族信息并被排除在外。基线人口统计学特征无统计学差异；原住民人群的高血压（P=.03）和糖尿病（P＜.001）发生率更高。单变量分析显示，1 年 BMI 变化相似（原住民：15.8±6.0kg/m；非原住民：16.1±5.6kg/m，P=.362）。调整后，两组在 6 个月（效应量=.07，95%置信区间-0.45 至 0.58，P=.803）和 1 年（效应量= -.24，95%置信区间-0.93 至 0.45，P=.489）时 BMI 变化无差异。尽管基线时存在差异，但两组在 1 年时的合并症发生率相似。1 年时非原住民的 6 个月和 1 年随访率较高（P＜.001，P=.005）。
在原住民和非原住民患者中，体重减轻和肥胖相关合并症的缓解情况相似。手术的可及性、患者选择和长期结果值得进一步研究。
