Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina, Greenville, NC, USA.
Department of Health Services and Information Management, East Carolina University, Greenville, NC, USA.
Am Surg. 2024 Nov;90(11):2710-2716. doi: 10.1177/00031348241248807. Epub 2024 Apr 23.
This study sought to identify factors that contribute to disparities in access to bariatric surgery in North Carolina (NC).
Using the rate of bariatric surgery in the county with the best health outcome as the reference, we calculated the Surgical Equity Index (SEI) in the remaining counties in NC.
Approximately 2.95 million individuals (29%) were obese in NC. There were 992 (.5%) bariatric procedures performed on a population of 194 209 individuals with obesity in the Reference County (RC). The mean SEI for bariatric surgery in NC was .47 (SD .17, range .15-.95). A statistically significant difference was observed in 89 counties. Univariable analyses identified the following variables to be significantly associated with the SEI: percent of population living in rural areas (% rural) (relative rate change in SEI [RR] = .994, 95% CI .92-.997; <.0001), median household income (RR = 1.0, 95% CI = 1.0-1.0; = .0002), prevalence of diabetes (RR = .947, 95% CI .917-.977; .0006), the primary care physician ratio (RR = .995, 95% CI .991-.998; = .006), and percent uninsured adults (RR = .955, 95% CI .927-.985; = .003). By multivariable hierarchical regression analysis, only the % rural remained statistically associated with a low SEI (RR = .995 per 1% increase in % rural, 95% CI = .992, .998; = .0002).
The percent rural is the most significant predictor of disparities in access to bariatric surgery. For every 1% increase in % rural, the rate of surgery decreased by .5%. Understanding the characteristics of rurality that are barriers to access is crucial to mitigate disparities in bariatric surgical access in NC.
本研究旨在确定导致北卡罗来纳州（NC）接受减重手术机会不平等的因素。
我们使用具有最佳健康结果的县的减重手术率作为参考，计算了 NC 其余县的手术公平指数（SEI）。
NC 约有 290 万人（29%）肥胖。在参考县（RC），对 194209 名肥胖人群进行了 992 次（0.5%）减重手术。NC 减重手术的平均 SEI 为.47（SD.17，范围.15-.95）。在 89 个县观察到统计学显著差异。单变量分析确定了与 SEI 显著相关的以下变量：居住在农村地区的人口比例（%农村）（SEI 的相对变化率 [RR] =.994，95%CI.92-.997；<.0001），家庭中位数收入（RR = 1.0，95%CI = 1.0-1.0；=.0002），糖尿病患病率（RR =.947，95%CI.917-.977；<.0006），初级保健医生比例（RR =.995，95%CI.991-.998；=.006）和未参保成年人比例（RR =.955，95%CI.927-.985；=.003）。通过多变量层次回归分析，只有 %农村仍然与低 SEI 具有统计学相关性（%农村每增加 1%，手术率降低 0.995%，95%CI =.992，.998；=.0002）。
农村人口比例是导致减重手术机会不平等的最重要预测因素。农村人口每增加 1%，手术率就会下降 0.5%。了解导致获得减重手术机会不平等的农村特征至关重要。
