The Inequity of Bariatric Surgery: Publicly Insured Patients Undergo Lower Rates of Bariatric Surgery with Worse Outcomes

Hennings, Dietric; Baimas-George, Maria; Al-Quarayshi, Zaid; Moore, Rachel; Kandil, Emad; DuCoin, Christopher

doi:10.1007/s11695-017-2784-5

Cited by 43 publications

(23 citation statements)

References 37 publications

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“…In countries where healthcare is mostly provided by public systems, such as Canada, the United Kingdom, Spain, Australia, and Brazil, constraints in access to surgery for obesity and metabolic disorders result from the high demand compared with limited availability of specialized services. Consequently, many centers have years-long waiting lists with hundreds or thousands of patients [4][5][6][7][8]. To deal with this problem, several countries have adopted obesity severity classification systems to identify not only individuals for whom surgical treatment would be most beneficial but also to ascertain individuals with extreme disease severity for whom the surgical risk would be greater than its benefits [9][10][11][12].…”

mentioning

confidence: 99%

The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services

Ogassavara

Dias

Pajecki

et al. 2020

Surgery for Obesity and Related Diseases

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mentioning

confidence: 99%

The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services

Ogassavara

Dias

Pajecki

et al. 2020

Surgery for Obesity and Related Diseases

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“…14 Hennings et al found that delays and insurance rejection among the publicly insured seeking bariatric procedures lead to a threefold increase in mortality. 17 The NIH eligibility criteria 29 only allows class II obesity to receive surgery if they have a related comorbidity. Therefore, disease burden bears influence on which patients receive LRYGB at this lower BMI.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Social Determinants and Socioeconomic Status on Laparoscopic Roux-En-Y Gastric Bypass for Weight Loss: An Analysis of the National Inpatient Sample

et al. 2021

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Objective In the United States, Black and Hispanic patients have a higher prevalence of obesity than Whites (49.6 vs. 44.8 vs. 42.2%, respectively). Despite higher rates of obesity among minority populations, bariatric surgery is performed at higher obesity levels in minorities than in Whites. This study examines the effects of various socioeconomic factors such as race, payer type, and income on the likelihood of undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) at class II versus class III obesity and their associated complications. Materials and Methods National Inpatient Sample (NIS) from 2016 to 2017 was queried to identify patients at least 18 years of age with a concomitant diagnosis of class II or class III obesity who underwent LRYGB. We analyzed obesity level at the time of LRYGB (class II vs. class III), postoperative intestinal obstruction during the admission, and occurrence of any noninfectious complication related to the surgery as our main outcomes. A multivariate logistic regression model was utilized to assess the association between our outcomes and socioeconomic factors associated with the admission. Results A total of 76,405 LRYGB operations were included. Out of this total, 83% (63,640) LRYGB operations were in class III obesity. Black patients had a lower rate (11.6%) of LRYGB procedures at class II obesity than White (17.6%) and Hispanic (18%) patients (p < 0.001). Medicare, Medicaid, and lower income quartiles also showed lower rates of operation at class II obesity (p < 0.001). Black patients were 29% (95% confidence interval [CI]: 0.61–0.83, p < 0.001) less likely than Whites to have a LRYGB procedure at class II obesity, they were 119% (95% CI: 1.17–4.11, p = 0.0014) more likely to suffer a postoperative intestinal obstruction, and they were 93% (95% CI: 1.31–2.84, p < 0.001) more likely to suffer a noninfectious complication. Conclusion Socioeconomic disparities in the surgical management of severe obesity persist in the United States, especially for LRYGB. This study highlights multiple demographic factors that led to LRYGB at later obesity levels. Black patients were also more likely to be associated with postoperative complications during the admission. The determinants of health disparities in obese patients need to be examined further to reduce potential long-term morbidity and mortality in minorities. Further research is also required to identify the adverse effects of health disparities in patients with severe obesity and obesity-related comorbidities.

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“…Of the nearly 90 thousand in-patient bariatric surgical procedures that were performed in 2006, 75% were white, 55% were above median income, and 82% had private insurance. 3 Additionally Hennings et al 13 found in a case control analysis of the National Inpatient Sample from 2003 through 2010, the population with public insurance has a higher rate of obesity and obesity-related complications but is significantly less likely to undergo bariatric surgery than the privately insured population.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Access to Bariatric Surgery in Texas 2013–2017

Clapp¹,

Barrientes²,

Dodoo³

et al. 2020

JSLS

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Background: Access to bariatric care varies across regions, ethnic, and racial groups. Some of these variations may be due to insurance status or socioeconomic status. There are also regional and state variations in access to metabolic and bariatric surgery (MBS). The Texas Inpatient Public Use Data File (IPUDF) and Texas Outpatient Public Use Data File is a state-mandated database that collects information on demographics, procedures, diagnoses, and cost on almost all admissions in Texas. We used them to examine racial disparities in MBS over a 5-y period. Methods: The IPUDF and Texas Outpatient Public Use Data File were examined from the years 2013 through, 2017. We included all patients undergoing a laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy and examined the demographics of these patients. Race and ethnicity are reported separately. We used U.S. Census Bureau statistics and the Texas Department of State Health Services statistics to determine the crude (unadjusted) and adjusted procedure rates of patients undergoing MBS. Results: In the IUPUDF, the crude unadjusted procedure rate for blacks undergoing MBS was 7.29 per 10,000 population followed by 6.85 per 10,000 for non-Hispanic whites. Hispanics had the lowest rate at 3.20 per 10,000. When adjusted for sex, obesity, age, and race, blacks still had a higher rate of access followed by whites and then Hispanics. Conclusions: There are disparities to access for bariatric surgery in Texas. Blacks have the greatest access followed by whites. Hispanics have the lowest procedure rate per population.

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The Inequity of Bariatric Surgery: Publicly Insured Patients Undergo Lower Rates of Bariatric Surgery with Worse Outcomes

Abstract: Publicly insured patients are significantly less likely to undergo bariatric surgery. As a group, these patients experience higher rates of obesity and related complications and thus are most in need of bariatric surgery.

Cited by 43 publications

References 37 publications

The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services

The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services

The Effect of Social Determinants and Socioeconomic Status on Laparoscopic Roux-En-Y Gastric Bypass for Weight Loss: An Analysis of the National Inpatient Sample

Disparities in Access to Bariatric Surgery in Texas 2013–2017

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