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Suvarnakar A, Hose BZ, Busog DN, McCloud S, Chao GF, Miller K, Pardo I, Alimi Y. Falling short in bariatric surgery: An exploration of key barriers and motivators of attrition. Am J Surg 2024; 236:115827. [PMID: 39029267 DOI: 10.1016/j.amjsurg.2024.115827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND In the United States, obesity-related diseases pose significant healthcare challenges, with bariatric surgery offering a potential solution. However, bariatric surgery completion rates, particularly among Black and Hispanic populations, remain low. OBJECTIVE This study applied the Theoretical Domains Framework (TDF) to explore behavioral factors influencing bariatric surgery program attrition among a majority Black participant population to inform interventions for improving attrition. METHODS We conducted semi-structured interviews with 40 surgical and non-surgical participants and conducted deductive content analysis informed by six TDF constructs to explore factors influencing bariatric surgery program attrition. RESULTS Participants' decision-making regarding bariatric surgery is influenced by behavioral factors, including knowledge, skills, social roles, beliefs about capabilities, optimism, and beliefs about consequences. CONCLUSION Understanding multifaceted factors influencing bariatric surgery attrition will inform the development of tailored interventions that address knowledge gaps, enhance skills, and consider social role conflicts to improve patient engagement and decision-making in managing obesity, especially for Black populations.
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Affiliation(s)
| | - Bat-Zion Hose
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, 20008, USA
| | - Deanna-Nicole Busog
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, 20008, USA
| | - Summer McCloud
- Georgetown University School of Medicine, Washington, DC, USA
| | - Grace F Chao
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Kristen Miller
- Georgetown University School of Medicine, Washington, DC, USA; National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, 20008, USA
| | - Ivanesa Pardo
- Georgetown University School of Medicine, Washington, DC, USA; Division of Minimally Invasive Surgery and Bariatric Surgery, Medstar Washington Hospital Center, Washington, DC, USA
| | - Yewande Alimi
- Georgetown University School of Medicine, Washington, DC, USA; Division of Minimally Invasive Surgery and Bariatric Surgery, Medstar Washington Hospital Center, Washington, DC, USA; Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
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2
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Majstorovic M, Chur-Hansen A, Andrews JM, Burke A. Factors associated with progression or non-progression to bariatric surgery in adults: A systematic review. Obes Rev 2024; 25:e13698. [PMID: 38268336 DOI: 10.1111/obr.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Access to bariatric surgery is limited, and the factors related to undergoing or not undergoing the procedure are poorly understood. To this end, a systematic review of PubMed, Embase, PsycINFO, and CINAHL was conducted to deduce the factors associated with progression or non-progression to bariatric surgery. Quantitative and qualitative English-language articles ranging in date from database conception to September 2023 were included. Eligible studies employed adult participants (18 years of age or above) who had been referred for bariatric surgery. A total of 57 studies were identified. Fifteen key factors were found, alongside six less frequently studied factors: age, sex, BMI, race and ethnicity, distance to clinic, socio-economic status, insurance coverage, physical health, psychological health, eating history and habits, substance use and smoking, social influence and relationships, pre-surgery process and requirements, surgery-related concerns, choice of surgery, and others (emergency room visitation, COVID-19 virus, health literacy, appearance perceptions, time-off work, and stigma related to surgery). No factors were found to be reliably associated with progression or non-progression to bariatric surgery; however, the nature of these findings is tentative considering methodological flaws and limited research. Further studies are required to elucidate potential inequities in bariatric surgery access and educate policymakers and health professionals.
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Affiliation(s)
- Mia Majstorovic
- The School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anna Chur-Hansen
- The School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jane M Andrews
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Surgery Program, The Central Adelaide Local Health Network (CALHN), Adelaide, South Australia, Australia
| | - Anne Burke
- The School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, CALHN, Adelaide, South Australia, Australia
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Paolino L, Le Fouler A, Epaud S, Bathaei S, Mokhtari N, Lazzati A. Preoperative Follow-up in Bariatric Surgery: Why They Give Up? Rate, Causes, and Economic Impact of Dropout. Obes Surg 2023; 33:2652-2657. [PMID: 37477831 DOI: 10.1007/s11695-023-06742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Preoperative attrition is highly prevalent in patients referred for bariatric surgery. Little information is available neither on reasons reported by patients for attrition in knowledge nor costs of attrition in a publicly funded health system. OBJECTIVES To assess the reasons for the attrition of bariatric candidates and calculate its economic impact on a population with obesity in a public hospital in France. METHODS This is a retrospective study including all bariatric surgery candidates between 2014 and 2018 in our Center of Excellence in Obesity Care. Data were extracted from the hospital information system, and patient-related outcomes were collected via a standardized questionnaire. Economic analysis was performed. Primary outcome was to analyze the rate of preoperative attrition. Secondary outcome was reasons for discontinuation and their economic impact. RESULTS In total, 1360 patients were referred for bariatric surgery at our hospital, and 1225 were included in the study. Attrition rate in preoperative phase was 46.8%. Three factors were significantly associated with follow-up fragmentation risk: unemployment (OR 0.52, 95% CI 0.29-0.7, p < 0.001), active smoking (OR 2.24, 95% CI 1.53-5.15, p < 0.001), and body mass index (OR 0.98, 95% CI 0.97-1.00, p = 0.036). Average cost to the healthcare system was €792 for each patient who dropped out. CONCLUSIONS We identified predictors and patient-reported factors that seem to be beyond the possibility of removal by health professionals. We should consider and address preventable factors, through the development of care pathways tailored to the individual profile of a patient.
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Affiliation(s)
- Luca Paolino
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
| | - Adrien Le Fouler
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France.
| | - Salomé Epaud
- Kaduceo SAS, 96 Avenue Jules Julien, 31400, Toulouse, France
| | - Sarah Bathaei
- Nutrition Unit, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
| | - Nawel Mokhtari
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
- INSERM IMRB U955, Université Paris-Est Créteil, Créteil, France
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4
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Ngenge S, Xie L, McAdams C, Almandoz JP, Mathew MS, Schellinger JN, Kapera O, Marroquin E, Francis J, Kukreja S, Schneider BE, Messiah SE. Depression and Anxiety as Predictors of Metabolic and Bariatric Surgery Completion Among Ethnically Diverse Patients. Obes Surg 2023; 33:2166-2175. [PMID: 37217806 PMCID: PMC10202355 DOI: 10.1007/s11695-023-06652-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Mental health conditions including depression and anxiety are often prevalent among metabolic and bariatric surgery (MBS) patients, but it is not known if these conditions predict the decision to complete the procedure and if this varies by race and ethnicity. This study aimed to determine if depression and anxiety are associated with MBS completion among a race/ethnically diverse sample of patients. METHODS This prospective cohort study included participants who were referred to an obesity program or two MBS practices between August 2019 and October 2022. Participants completed the Mini International Neuropsychiatric Interview (MINI) instrument to determine history of anxiety and/or depression, as well as MBS completion status (Y/N). Multivariable logistic regression models determined the odds of MBS completion by depression and anxiety status adjusting for age, sex, body mass index, and race/ethnicity. RESULTS The sample consisted of 413 study participants (87 % women, 40% non-Hispanic White, 39% non-Hispanic Black, and 18% Hispanic). Participants with a history of anxiety were less likely to complete MBS (aOR = 0.52, 95% CI = 0.30-0.90, p = 0.020). Women had increased odds of a history of anxiety (aOR = 5.65, 95% CI = 1.64-19.49, p = 0.006) and of concurrent anxiety and depression (aOR = 3.07, 95% CI = 1.39-6.79, p = 0.005) compared to men. CONCLUSIONS Results showed that participants with anxiety were 48% less likely to complete MBS compared to those without anxiety. Additionally, women were more likely to report a history of anxiety with and without depression versus men. These findings can inform pre-MBS programs about risk factors for non-completion.
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Affiliation(s)
- Sophia Ngenge
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Luyu Xie
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Sunil Mathew
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olivia Kapera
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- University of Texas Health Science Center, School of Public Health, Austin, TX, USA
| | - Elisa Marroquin
- Department of Nutritional Sciences, Texas Christian University, Fort Worth, TX, USA
| | - Jackson Francis
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | | | - Benjamin E Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA.
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA.
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Sher T, Diab AR, Mhaskar R, Docimo S, Sujka J, DuCoin C. Evaluating the Spanish readability of American Society for Metabolic and Bariatric Surgery (ASMBS) Centers of Excellence (COE) websites. Surg Endosc 2023:10.1007/s00464-023-09978-9. [PMID: 36914781 PMCID: PMC10010650 DOI: 10.1007/s00464-023-09978-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Healthcare disparities continue to be an ongoing struggle in Bariatrics. Limited availability of Spanish online material may be a correctible barrier for accessibility to Hispanic patients. We sought to evaluate accredited Bariatric Centers of Excellence (COE) for Spanish readability via their websites to determine accessibility for Spanish speakers. METHODS This was an internet research study. 103 COE accredited by American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) were evaluated and assigned one of five Spanish Visibility Categories. The United States was divided into 4 regions. Regional Spanish visibility was calculated by dividing each category count by the number of institutions in each region. County Spanish-speaking populations were obtained from the US Census Bureau's 2009-2013 American Community Survey. Differences in their distributions across the Spanish Visibility Categories were investigated using the Mann-Whitney U test. RESULTS 25% of websites were translatable to Spanish, and a regional discrepancy was found with 61% translatable in the West, 19% in Northeast, 19% in Midwest, and 15% in South. Median Spanish-speaking population was higher in counties where websites were translatable to Spanish than where websites were not translatable. CONCLUSION Healthcare disparities in Bariatrics continue to be an ongoing struggle. We suggest that Spanish readability for ASMBS ACS COE websites should be improved regardless of geographic differences in Spanish-speaking populations. We believe it would be valuable for these websites to have standards for readability of Spanish and other languages.
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Affiliation(s)
- Theo Sher
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
| | - Abdul-Rahman Diab
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Salvatore Docimo
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Joseph Sujka
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Christopher DuCoin
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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Gudur AR, Geng C, Radlinski M, Yang Z, Shami VM, Wang AY, Podboy A. Endoscopic Sleeve Gastroplasty: A Safe Bariatric Intervention for Class III Obesity (BMI > 40). Obes Surg 2023; 33:1133-1142. [PMID: 36717436 DOI: 10.1007/s11695-023-06475-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Endoscopic sleeve gastroplasty (ESG) is primarily offered to patients with class I and II obesity (BMI 30-40), although there are no guidelines specifying applicability. There is little data comparing ESG to bariatric surgery in patients with class III obesity (BMI > 40). This study evaluates the short-term safety of ESG compared to sleeve gastrectomy (SG) and gastric bypass (RYGB) in patients with class III obesity. METHODS We retrospectively analyzed over 500,000 patients who underwent ESG, SG, and RNYGB from 2016 to 2020 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. ESG patients were stratified by BMI to compare outcomes between class I and II versus class III obese patients. Class III obese patients who underwent ESG were also propensity matched to SG and RNYGB patients for matched comparisons. Primary outcomes included adverse events (AE), readmissions, re-operations, and re-interventions within 30 days. Secondary outcomes included procedure time, length of stay (LOS), and total body weight loss (%TBWL) at 30 days. RESULTS Among ESG patients, those with BMI > 40 had no difference in AE, readmissions, or re-interventions versus patients with BMI 30-40 (p > 0.05), while achieving greater %TBWL at 30 days (p < 0.05). In comparison to surgery, ESG had similar AE to SG and less than RNYGB, while producing comparable %TBWL to SG and RNYGB at 30 days. CONCLUSIONS The feasibility and safety of ESG in patients with class III obesity are comparable to patients with class I and II obesity. Additionally, the safety of ESG in patients with class III obesity is comparable to SG and safer than RYGB. Endoscopic sleeve gastroplasty: a safe bariatric intervention for class III obesity (BMI > 40).
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Affiliation(s)
- Anuragh R Gudur
- Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA, 22901, USA
| | - Calvin Geng
- Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA, 22901, USA
| | - Mark Radlinski
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, 22901, USA
| | - Zequan Yang
- Department of Surgery, University of Virginia, Charlottesville, VA, 22903, USA
| | - Vanessa M Shami
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, 22901, USA
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, 22901, USA
| | - Alexander Podboy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, 22901, USA
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7
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Comparison of endoscopic sleeve gastroplasty versus surgical sleeve gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database analysis. Gastrointest Endosc 2023; 97:11-21.e4. [PMID: 35870507 DOI: 10.1016/j.gie.2022.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Endoscopic sleeve gastroplasty (ESG) is an incisionless, transoral, restrictive bariatric procedure designed to imitate sleeve gastrectomy (SG). Comparative studies and large-scale population-based data are limited. Additionally, no studies have examined the impact of race on outcomes after ESG. This study aims to compare short-term outcomes of ESG with SG and evaluate racial effects on short-term outcomes after ESG. METHODS We retrospectively analyzed over 600,000 patients in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database from 2016 to 2020. We compared occurrences of adverse events (AEs), readmissions, reoperations, and reinterventions within 30 days after procedures. Multivariate regression evaluated the impact of patient factors, including race, on AEs. RESULTS A total of 6054 patients underwent ESG and 597,463 underwent SG. AEs were low after both procedures with no significant difference in major AEs (SG vs ESG: 1.1% vs 1.4%; P > .05). However, patients undergoing ESG had more readmissions (3.8% vs 2.6%), reoperations (1.4% vs .8%), and reinterventions (2.8% vs .7%) within 30 days (P < .05). Race was not significantly associated with AEs after ESG, with black race associated with a higher risk of AEs in SG. CONCLUSIONS ESG demonstrates a comparable major AE rate with SG. Race did not impact short-term AEs after ESG. Further prospective studies long-term studies are needed to compare ESG with SG.
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8
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Wong WG, Perez Holguin RA, Butt M, Rigby A, Rogers AM, Shen C. Racial Differences in Bariatric Surgical Approach: a Cross-Sectional National Inpatient Sample Analysis. Obes Surg 2022; 32:3359-3367. [PMID: 35930116 DOI: 10.1007/s11695-022-06227-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Although racial inequalities in referral and access to bariatric surgical care have been well reported, racial difference in the selection of surgical techniques is understudied. This study examined factors associated with the utilization of the two main bariatric surgical techniques: laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). MATERIALS AND METHODS The National Inpatient Sample database was queried for patients who underwent elective LSG or LRYGB for the treatment of severe obesity. Chi-square tests and multivariable logistic regression assessed associations of surgical approach with patient and facility characteristics. Sensitivity analyses examined the following body mass index (BMI) subgroups: < 40.0 kg/m2, 40.0-44.9 kg/m2, 45.0-49.9 kg/m2, and ≥ 50.0 kg/m2. RESULTS Within the final cohort (N = 86,053), 73.0% (N = 62,779) underwent LSG, and 27.0% (N = 23,274) underwent LRYGB. Patients with BMI 45.0-49.9 kg/m2 (OR = 0.85) and BMI ≥ 50.0 kg/m2 (OR = 0.80) were less likely to undergo LSG than patients with BMI 40.0-45.0 kg/m2 (all p < 0.001). However, Black (OR = 1.74) and White Hispanic patients (OR = 1.30) were more likely to undergo LSG than White non-Hispanic patients (all p < 0.005). In the BMI ≥ 50.0 kg/m2 group, Black patients were still more likely to undergo LSG compared to White non-Hispanic patients (OR = 1.69, p < 0.001), while Asians/Pacific Islanders were less likely to receive LSG than White non-Hispanic patients (OR = 0.41, p < 0.05). CONCLUSION In this observational study, we identified racial differences in the selection of common bariatric surgical approaches across various BMI categories. Future investigations are warranted to study and to promote awareness of the racial/ethnic influence in attitudes on obesity, weight loss, financial support, and surgical risks during bariatric discussions with minorities.
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Affiliation(s)
- William G Wong
- Department of General Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of General Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Melissa Butt
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA
| | - Andrea Rigby
- Division of Minimally Invasive Surgery, Department of Surgery, Penn State Health, Hershey, PA, USA
| | - Ann M Rogers
- Division of Minimally Invasive Surgery, Department of Surgery, Penn State Health, Hershey, PA, USA
| | - Chan Shen
- Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA. .,Division of Outcomes Research and Quality, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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9
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Luther JP, Fritz CD, Fanous E, Waken R, Hammond JG, Joynt Maddox KE. The Association of Race, Ethnicity, and Insurance Status With Outcomes in Hospitalized Patients With Ulcerative Colitis. GASTRO HEP ADVANCES 2022; 1:985-992. [PMID: 39131255 PMCID: PMC11307435 DOI: 10.1016/j.gastha.2022.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/19/2022] [Indexed: 08/13/2024]
Abstract
Background and Aims The impact of sociodemographic factors on outcomes in patients with ulcerative colitis (UC) is not well studied. We characterized the association of race/ethnicity and insurance status with procedures, length of stay (LOS), mortality, and cost of care in a cohort of hospitalized patients with UC. Methods Data from the National Inpatient Sample from 2016 to 2018 were used. Outcomes were analyzed using generalized estimating equations. All models included age, sex, income quartile, hospital diagnosis, hospital characteristics, and Elixhauser Comorbidity Index as well as the primary predictors. Results A total of 34,814 patients were included. Black (adjusted odds ratio [aOR] 0.46, 95% confidence interval [0.39-0.55]) or Hispanic (aOR 0.74, [0.64-0.86]) patients had lower odds of colectomy than White patients. Patients with Medicare (aOR 0.54, [0.48-0.62), Medicaid (aOR 0.51, [0.45-0.58]), or no insurance (aOR 0.42, [0.35-0.50]) had lower odds of colectomy than privately insured patients. Black patients had higher mortality than White patients (aOR 1.38, [1.07-1.78]). Patients with Medicare or Medicaid had 5% ([1.01-1.09]) and 9% longer LOS ([1.05-1.13]), respectively, than privately insured patients, while uninsured patients had a 6% shorter LOS ([0.90-0.97]). Hispanic or Asian/Native American patients had 11% ([1.06-1.15]) and 13% ([1.07-1.20]) higher costs, respectively, than White patients. Uninsured patients had 11% lower hospitalization costs than privately insured patients ([0.85-0.94]). Conclusion Hospitalized patients with UC differed significantly in rates of colectomy, mortality, LOS, and costs based on race/ethnicity and insurance status. Further research is needed to understand the cause of these differences and develop targeted solutions to reduce these inequities.
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Affiliation(s)
- Janki P. Luther
- Division of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Cassandra D.L. Fritz
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Erika Fanous
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - R.J. Waken
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - J. Gmerice Hammond
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Karen E. Joynt Maddox
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
- Center for Health Economics and Policy, Institute for Public Health at Washington University, St. Louis, Missouri
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