University of Michigan, Ann Arbor, MI, USA.
Henry Ford Health System, Detroit, USA.
Surg Endosc. 2023 Jan;37(1):564-570. doi: 10.1007/s00464-022-09292-w. Epub 2022 May 4.
Although bariatric surgery is the most effective treatment for obesity and weight-related comorbid diseases, utilization rates are disproportionately low among non-white patients. We sought to understand if variation in baseline characteristics or access to care exists between white and non-white patients.
Using a statewide bariatric-specific data registry, we evaluated all patients who underwent bariatric surgery between 2006 and 2020 and completed a preoperative baseline questionnaire, which included a question about self-identification of race. Patient characteristics, co-morbidities, and time from initial preoperative clinic evaluation to date of surgery were compared among racial groups.
A total of 73,141 patients met inclusion criteria with 18,741 (25.5%) self-identified as non-white. These included Black/African American (n = 11,904), Hispanic (n = 3448), Asian (n = 121), Native Hawaiian/Pacific Islander (n = 41), Middle Eastern (n = 164), Multiple (n = 2047) and other (n = 608). Non-white males were the least represented group, accounting for only 4% of all bariatric cases performed. Non-white patients were more likely to be younger (43.0 years vs. 46.6 years, p < 0.0001), disabled (16% vs. 11.4%, p < 0.0001) and have Medicaid (8.4% vs. 3.8%, p < 0.0001) when compared to white patients, despite having higher rates of college education (78.0% vs. 76.6, p < 0.0001). In addition, median time from initial evaluation to surgery was also longer among non-white patients (157 days vs. 127 days, p < 0.0001), despite having higher rates of patients with a body mass index above 50 kg/m (39.0% vs. 33.2%, p < 0.0001).
Non-white patients undergoing bariatric surgery represent an extremely diverse group of patients with more socioeconomic disadvantages and longer wait times when compared to white patients despite presenting with higher rates of severe obesity. Current guidelines and referral patterns for bariatric surgery may not be equitable and need further examination when considering the management of obesity within diverse populations to reduce disparities in care-of which non-white males are particularly at risk.
尽管减重手术是治疗肥胖和与体重相关的合并症的最有效方法，但在非白人患者中的利用率却低得不成比例。我们试图了解白人和非白人患者之间是否存在基线特征或获得治疗方面的差异。
我们使用全州范围的专门的减重数据登记处，评估了在 2006 年至 2020 年间接受减重手术的所有患者，并完成了术前基线问卷调查，其中包括一个关于自我认定种族的问题。比较了不同种族组之间的患者特征、合并症以及从初次术前临床评估到手术日期的时间。
共有 73141 名患者符合纳入标准，其中 18741 名（25.5%）自我认定为非白人。其中包括黑种人/非裔美国人（n=11904）、西班牙裔（n=3448）、亚洲人（n=121）、夏威夷原住民/太平洋岛民（n=41）、中东人（n=164）、多种族（n=2047）和其他（n=608）。非白人男性是代表性最低的群体，仅占所有减重手术的 4%。与白人患者相比，非白人患者更年轻（43.0 岁比 46.6 岁，p<0.0001）、残疾（16%比 11.4%，p<0.0001）和拥有医疗补助（8.4%比 3.8%，p<0.0001），尽管他们的大学教育程度更高（78.0%比 76.6%，p<0.0001）。此外，与白人患者相比，非白人患者从初次评估到手术的中位时间也更长（157 天比 127 天，p<0.0001），尽管他们的体重指数超过 50kg/m2 的患者比例更高（39.0%比 33.2%，p<0.0001）。
与白人患者相比，接受减重手术的非白人患者代表了一个极其多样化的患者群体，他们在社会经济方面处于劣势地位，等待时间也更长，尽管他们的严重肥胖率更高。目前的减重手术指南和转诊模式可能并不公平，在考虑不同人群中肥胖的管理以减少护理差距时，需要进一步研究，其中非白人男性尤其面临风险。
