Association Between Medicaid Status, Social Determinants of Health, and Bariatric Surgery Outcomes

Abstract

Objective: To compare outcomes after bariatric surgery between Medicaid and non-Medicaid patients and assess whether differences in social determinants of health were associated with postoperative weight loss. Background: The literature remains mixed on weight loss outcomes and healthcare utilization for Medicaid patients after bariatric surgery. It is unclear if social determinants of health geocoded at the neighborhood level are associated with outcomes. Methods: Patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2008 to 2017 and had ≥1 year of follow-up within a large health system were included. Baseline characteristics, 90-day and 1-year outcomes, and weight loss were compared between Medicaid and non-Medicaid patients. Area deprivation index (ADI), urbanicity, and walkability were analyzed at the neighborhood level. Median regression with percent total body weight (TBW) loss as the outcome was used to assess predictors of weight loss after surgery. Results: Six hundred forty-seven patients met study criteria (191 Medicaid and 456 non-Medicaid). Medicaid patients had a higher 90-day readmission rate compared to non-Medicaid patients (19.9% vs 12.3%, P < 0.016). Weight loss was similar between Medicaid and non-Medicaid patients (23.1% vs 21.9% TBW loss, respectively; P = 0.266) at a median follow-up of 3.1 years. In adjusted analyses, Medicaid status, ADI, urbanicity, and walkability were not associated with weight loss outcomes. Conclusions: Medicaid status and social determinants of health at the neighborhood level were not associated with weight loss outcomes after bariatric surgery. These findings suggest that if Medicaid patients are appropriately selected for bariatric surgery, they can achieve equivalent outcomes as non-Medicaid patients.

Neighborhood deprivation and residential property values do not affect weight loss at 1 or 3 years after bariatric surgery

“…Consistent with other studies, neighborhood-level sociodemographic factors were not associated with %TWL at year 1 or year 3 [13,22,23]. Also consistent with other studies, race and ethnicity, age, and weight at the time of surgery were most strongly associated with %TWL after surgery at year 1 and year 3 [1, 2, 8, 14-16].…”

“…Studying individual‐ and neighborhood‐level sociodemographic indicators and their associations with cross‐sectional obesity prevalence is different than understanding predictors of weight change over time. The limited, recent evidence with weight‐loss surgery has shown that self‐reported occupation, education, and income have been associated with greater weight loss [19–21], whereas in a predominantly White sample, Medicaid status, area deprivation index, and walkability were not associated with bariatric surgery outcomes [22]. Also at the neighborhood level, zip code–derived median incomes [13] and urbanicity [23] did not lead to differential weight loss.…”

Comparative Safety of Sleeve Gastrectomy and Gastric Bypass up to 5 Years After Surgery in Patients With Medicaid

“…However, compared with privately insured patients, Medicaid patients experience the longest wait times for bariatric surgery, as well as substantially higher barriers to care and socioeconomic strain 37,38. Importantly, studies suggest that bariatric surgery is just as effective for patients with Medicaid as it is for patients with private insurance and Medicare 39,40. Therefore, continued efforts to ensure the equitable delivery of timely, high-quality bariatric surgical care to patients with Medicaid may improve their outcomes.…”

“…37,38 Importantly, studies suggest that bariatric surgery is just as effective for patients with Medicaid as it is for patients with private insurance and Medicare. 39,40 Therefore, continued efforts to ensure the equitable delivery of timely, high-quality bariatric surgical care to patients with Medicaid may improve their outcomes. This study also builds upon prior work evaluating bariatric surgical outcomes in minority and potentially vulnerable patient groups.…”

Patient Access, Utilization, and Perceptions of Neighborhood and Built Environment Resources

“…Patients also identified difficulty accessing nutrition/dietary services in their communities [ 20 ] and limited community programs as a barrier to physical activity [ 21 ]. However, in other work, neighborhood and built environment factors like walkability, geographic location, and socioeconomic deprivation did not affect patients’ postoperative behaviors or weight loss outcomes [ 22 , 23 ].…”