M. Pichardo1, G. Ortega2, L. Bacon1, I. Yi1, C. Emenari1, N. Changoor3, D. Tapscott1, D. Tran3, T. Fullum3 1Howard University College Of Medicine,Washington, DC, USA 2Howard University College Of Medicine,Outcomes Research Center, Department Of Surgery,Washington, DC, USA 3Howard University College Of Medicine,Howard University Hospital, Department Of Surgery,Washington, DC, USA
Introduction: Bariatric surgery plays a vital role in the management of refractory obesity and comorbidities. The relationship between socioeconomic status (SES) and bariatric surgery has not been well elucidated, specifically among minority populations. Our study aims to assess the relationship between bariatric surgery outcomes, insurance status and SES among African-American patients.
Methods: Conducted a retrospective chart review with a 12-months follow up. Included 256 African-American patients who underwent bariatric surgery at an urban, academic institution between 2008 and 2013. Data collected included preoperative risk factors, BMI, procedure type, excess weight loss and resolution of comorbidities. Median Household Income (MHI), obtained from census-tract level neighborhood SES data, was a proxy for patients’ SES and categorized into 3 groups: group 1 (>$101,578), group 2 ($62,435 to $101,577), and group 3 ($38,515 to $62,434). No patient had an MHI below $38,515. Insurance status at time of surgery was defined as public or private insurance. Outcomes of interest included percent excess weight loss (%EWL) and resolution of comorbidities (hypertension, diabetes, dyslipidemia, obstructive sleep apnea (OSA)). Chi-square and students’ T tests were used to assess the relationship between our outcomes of interest, insurance status, and MHI.
Results: The mean pre-operative BMI was 48.0 kg/m2. A majority of patients had private insurance (90%) and underwent LRYGB (82%). Forty-nine percent of the sample lived in neighborhoods with an MHI of $62,435 – $101,577 (group 2). Group 1 patients had a lower proportion of diabetes remission compared to group 2 and 3 patients (p=0.016). No differences in resolution of hypertension, diabetes, and dyslipidemia were observed by MHI. A greater proportion of patients with private insurance relative to public insurance experienced OSA remission (p=0.021). Remission of other comorbidities did not significantly differ in the two insurance populations. The highest %EWL was observed among patients residing in areas with MHI of $101,578 or more (p=0.0096; group 1). No difference was observed in %EWL among patients with private vs public insurance.
Conclusions: Our findings reveal differences in SES and insurance status in bariatric surgery outcomes among an African-American population. Patients with private insurance experienced improved OSA outcomes relative to patients with public insurance. Patients in higher MHI neighborhoods experienced greater %EWL than those in lower income areas. However, lower and middle MHI neighborhood patients had better resolution of diabetes compared to patients living in the highest income areas. Further research is warranted to fully understand the effect of SES. Moreover, healthcare providers and policy makers should consider means of mitigating the effects of SES and insurance status among minority and low-income populations that can benefit from bariatric surgery.