Department of Surgery, South Auckland Clinical Campus, The University of Auckland, c/- Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, 1640, New Zealand.
Research and Evaluation Office, Ko Awatea, Middlemore Hospital, Auckland, New Zealand.
Obes Surg. 2020 Sep;30(9):3459-3465. doi: 10.1007/s11695-020-04608-y.
In New Zealand (NZ), Indigenous Māori and Pacific peoples experience a higher burden of obesity and obesity-related disease. Counties Manukau Health (CMH) provides the largest public bariatric service in NZ housing a higher proportion (64%) of non-European groups (Asian, Pacific and Māori). This study investigated whether ethnic disparities in the receipt of bariatric surgery exist within one of the most ethnically diverse populations in NZ.
All patients accepted on to the CMH bariatric programme between 1 January 2011 and 31 December 2017 were identified through hospitalisation records. Logistic regression modelling with multivariate adjustment was utilised to assess the likelihood (odds ratio) of receipt of bariatric surgery by ethnicity.
A total of 2519 referrals were received, of which 1051 proceeded to surgery. The proportion of patients referred who eventually underwent bariatric surgery was significantly higher for Other Europeans (68%) and NZ Europeans (63%) compared to Asian (42%), Māori (41%) and Pacific peoples (28%, p < 0.05). The likelihood of receipt of bariatric surgery was significantly lower for Māori (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42-0.68) and Pacific (OR, 0.3; 95%CI, 0.23-0.40). These disparities were not explained by differences in socio-demographics, comorbidity or attrition.
Ethnic disparities in the receipt of publicly funded bariatric surgery exist where NZ European and Other European patients are more likely to gain access to publicly funded bariatric surgery. These findings challenge current selection criteria and prompt discussion around whether equity targets based on ethnicity need to be established.
在新西兰（NZ），土著毛利人和太平洋岛民面临更高的肥胖和肥胖相关疾病负担。克赖斯特彻奇市卫生局（CMH）提供了新西兰最大的公共减重服务，其中非欧洲人群（亚洲人、太平洋岛民和毛利人）的比例更高（64%）。本研究调查了在新西兰人口最多样化的人群之一中，接受减重手术是否存在种族差异。
通过住院记录，确定了 2011 年 1 月 1 日至 2017 年 12 月 31 日期间在 CMH 减重计划中接受治疗的所有患者。使用多变量调整的逻辑回归模型来评估种族对接受减重手术的可能性（比值比）。
共收到 2519 份转诊申请，其中 1051 例接受了手术。最终接受减重手术的患者中，其他欧洲人（68%）和新西兰欧洲人（63%）的比例明显高于亚洲人（42%）、毛利人（41%）和太平洋岛民（28%，p<0.05）。毛利人（比值比 [OR]，0.53；95%置信区间 [CI]，0.42-0.68）和太平洋岛民（OR，0.3；95%CI，0.23-0.40）接受减重手术的可能性明显较低。这些差异无法用社会人口统计学、合并症或流失率的差异来解释。
在接受公共资助的减重手术方面存在种族差异，新西兰欧洲人和其他欧洲患者更有可能获得公共资助的减重手术。这些发现对当前的选择标准提出了挑战，并促使人们讨论是否需要根据种族制定公平目标。
