Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
Surg Endosc. 2020 Jun;34(6):2630-2637. doi: 10.1007/s00464-019-07034-z. Epub 2019 Aug 5.
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.
尽管在极端肥胖症的外科治疗方面的安全性和有效性有所提高，但与其他患者群体相比，男性和少数族裔接受代谢和减重手术（MBS）的可能性较低。本研究检查了接受 MBS 的机会中的种族和性别差异，以了解导致这些问题的机制，并提出缩小差距的策略。
使用 2013-2014 年全国健康和营养调查数据，我们根据体重指数（BMI）和合并症情况，估计了按种族和性别划分的有资格接受 MBS 的个体比例。我们分析了 2015 年 MBS 认证和质量改进计划参与者使用数据文件，以检查非裔美国男性（AA）和白人男性之间的患者特征、合并症和术后结果差异。使用无条件逻辑回归模型确定不良结局的预测因素。
AA 男性占合格患者的 11%，但实际 MBS 患者仅占 2.4%。与白人男性相比，AA 男性更年轻，BMI 更高，更有可能患有高血压、肾功能不全、需要透析病史，且美国麻醉师协会（ASA）分级为 4 级或 5 级（所有 P 值均<0.01）。手术后，AA 男性更有可能出现术后并发症（调整后的优势比（aOR）为 1.25，95%置信区间（CI）为 1.02-1.52）和住院时间超过 4 天（aOR 为 1.51，95%CI 为 1.26-1.82），与白人男性相比。
尽管 AA 男性在 BMI 和肥胖相关合并症方面都有资格接受 MBS，但他们接受 MBS 的可能性明显较低。接受手术的 AA 男性比白人男性明显更年轻，但与白人男性和所有女性相比，他们的合并症也更多。需要进一步进行患者、系统和提供者层面障碍的纵向研究，以了解和解决这些差异。
