Pratt Keeley J, Hanks Andrew S, Miller Harvey J, Outrich Michael, Breslin Lindsay, Blalock Jamie, Noria Sabrena, Brethauer Stacy, Needleman Bradley, Focht Brian
Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio; Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio.
Surg Obes Relat Dis. 2023 Apr;19(4):318-327. doi: 10.1016/j.soard.2022.12.033. Epub 2022 Dec 30.
While social determinants of health (SDoH) have gained attention for their role in weight loss following bariatric surgery, electronic health record (EHR) data provide limited information beyond demographics associated with disparities in weight loss.
To integrate EHR, census, and county data to explore disparities in SDoH and weight loss among patients in the largest populous county of Ohio.
Seven hundred seventy-two patients (82.1% female; 37.0% Black) who had primary bariatric surgery (48.7% gastric bypass) from 2015 to 2019 at Ohio State University.
EHR variables included race, insurance, procedure, and percent total weight lost (%TWL) at 2/3, 6, 12, and 24 months. Census variables included poverty and unemployment rates. County variables included food stores, fitness/recreational facilities, and open area within a 5- and 10-minute walk from home. Two mixed multilevel models were conducted with %TWL over 24 months, with visits as the between-subjects factor; race, census, county, insurance, and procedure variables were covariates. Two additional sets of models determined within-group differences for Black and White patients.
Access to more food stores within a 10-minute walk was associated with greater %TWL over 24 months (P = .029). Black patients with access to more food stores within a 10-minute (P = .017) and White patients with more access within a 5-minute walk (P = .015) had greater %TWL over 24 months. Black patients who lived in areas with higher poverty rates (P = .036) experienced greater %TWL over 24 months. No significant differences were found for unemployment rate or proximity to fitness/recreational facilities and open areas.
Close proximity to food stores is associated with better weight loss 2 years after bariatric surgery. Lower poverty levels did not negatively affect weight loss in Black patients.
虽然健康的社会决定因素（SDoH）在减肥手术后体重减轻中的作用已受到关注，但电子健康记录（EHR）数据提供的信息有限，除了与体重减轻差异相关的人口统计学信息外。
整合电子健康记录、人口普查和县级数据，以探索俄亥俄州人口最多的县患者在健康的社会决定因素和体重减轻方面的差异。
2015年至2019年在俄亥俄州立大学接受初次减肥手术（48.7%为胃旁路手术）的772名患者（82.1%为女性；37.0%为黑人）。
电子健康记录变量包括种族、保险、手术方式以及术后2/3个月、6个月、12个月和24个月时的总体重减轻百分比（%TWL）。人口普查变量包括贫困率和失业率。县级变量包括离家步行5分钟和10分钟路程内的食品店、健身/娱乐设施和开放区域。进行了两个混合多层次模型，以24个月内的%TWL为指标，将就诊作为组间因素；种族、人口普查、县级、保险和手术方式变量作为协变量。另外两组模型确定了黑人和白人患者的组内差异。
离家步行10分钟路程内有更多食品店与24个月内更高的%TWL相关（P = 0.029）。离家步行10分钟路程内有更多食品店的黑人患者（P = 0.017）和离家步行5分钟路程内有更多食品店的白人患者（P = 0.015）在24个月内有更高的%TWL。生活在贫困率较高地区的黑人患者在24个月内有更高的%TWL（P = 0.036）。在失业率或与健身/娱乐设施和开放区域的距离方面未发现显著差异。
减肥手术后两年，靠近食品店与更好的体重减轻相关。较低的贫困水平对黑人患者的体重减轻没有负面影响。
