U. Deonarine5, G. Ortega1, C. K. Zogg3, R. Altafi6, D. J. Taghipour6, N. Changoor2, D. D. Tran2, E. E. Cornwell2, T. M. Fullum1 1Howard University College Of Medicine,Division Of Minimally Invasive Surgery/ Department Of Surgery/ Howard University College Of Medicine,Washington, DC, USA 2Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 3Yale University School Of Medicine,New Haven, CT, USA 4Howard University College Of Medicine,Washington, DC, USA 5Howard University College Of Medicine,Department Of Medicine,Washington, DC, USA 6Howard University College Of Medicine,Outcomes Research Center, Department Of Surgery,Washington, DC, USA
Introduction:
Morbid obesity is a modifiable risk factor for many diseases that substantially impact the burden of care in the United States. Research has shown morbid obesity and obesity related complications to be more prevalent in minorities and lower socioeconomic classes. Bariatric surgery is an effective treatment for morbid obesity but continues to be underutilized in the population that may benefit the most. Our objective is to determine if the utilization of bariatric surgery differs by socioeconomic and demographic categorization among morbidly obese patients by analyzing data from a national database.
Methods:
We conducted a retrospective review of the Nationwide Inpatient Sample (NIS) database from 2005 to 2013, selecting for patients with a diagnosis of morbid obesity. Data analyzed included patient characteristics such as demographics, co-morbid conditions, inpatient events, and post-operative morbidity and mortality. Cases were dichotomized into those who received bariatric surgery and those who did not. The two groups were compared utilizing t-test and chi-2 analysis when appropriate. A multivariate analysis was performed adjusting for patient characteristics and co-morbid conditions evaluating utilization by socioeconomic and demographic characteristics.
Results:
A total of 2,040,869 patients were morbidly obese. Of those the majority were White (68%), female (67%), and had a mean age of 53 years (SD+- 15). Overall, most patients had Medicare (39%), followed by private insurance (36%) and Medicaid (17%). Regarding median household income (MHI) the majority were in the lowest income quartile (32%), followed by second income quartile (28%), third income quartile (23%) and highest income quartile (17%). Nine percent of patients underwent bariatric surgery (n=184,615). Of the patients undergoing bariatric surgery most were White (72%, p<0.001), female (79%, p<0.001), were younger (45 vs. 54 years, p<0.001), in the third income quartile (27%, p<0.001) and had private insurance (70%, p<0.001). On adjusted analysis morbidly obese Black (OR 0.515, 95%CI: 0.506-0.525), Hispanic (OR 0.751, 95%CI: 0.736-0.768), Asian/ Pacific Islander (OR 0.645, 95%CI: 0.597-0.699) and Native American (OR 0.749, 95%CI: 0.695-0.807) were less likely to undergo bariatric surgery when compared to White patients. Regarding MHI, the second income quartile (OR 1.53, 95%CI: 1.49-1.55), the third (OR 1.85, 95%CI: 1.82-1.89) and fourth (OR 2.71, 95%CI: 2.66-2.76) were more likely to have bariatric surgery. Patients with private insurance were more likely to have bariatric surgery (OR 4.28, 95%CI: 4.19-4.36), while those with Medicaid insurance were less likely (OR 0.67, 95%CI: 0.65-0.69) when compared to Medicare insurance.
Conclusion:
Increased utilization of bariatric surgery may reduce the impact of the obesity epidemic. It is essential that the population most affected by morbid obesity has access to this life changing intervention.