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HISPANIC ETHNICITY IS ASSOCIATED WITH DECREASED ODDS OF BARIATRIC SURGERY: A NATIONWIDE ANALYSIS
Paul T. Kroner*, Andree Koop, Melissa Stewart, Frank Lukens
Mayo Clinic Florida, Jacksonville, FL
Introduction
As rates of obesity continue to rise, bariatric surgery (BS) has emerged as a measure to achieve weight loss and improve obesity-related comorbidities. Disparities may exist in ethnic minorities that may limit their access to BS. The Hispanic population continues to grow and now represents 17% of the US population, for which its importance to the healthcare system cannot be understated. Therefore, the aim of this study was to assess the use of BS and other healthcare outcomes in Hispanic patients in the US using a national database.
Methods
Case-control study using the NIS 2014, the largest publically available inpatient database in the US. All patients with ICD-9 CM codes for BS were included. None were excluded. Hispanic patients were identified within the database. Population estimates were obtained from the US National Census Bureau. The primary outcome was the use of BS in Hispanics compared to others. Secondary outcomes were inpatient mortality, morbidity (shock, ICU stay, and multi-organ failure); resource utilization; length of hospital stay (LOS), total hospitalization charges and costs. Propensity score matching was used to create a 1:1 matching population, and was regressed against gender, age and Charlson Comorbidity Index. Multivariate analysis was used to adjust for, income in patients' zip code, hospital region, location, size and teaching status.
Results
105,435 patients underwent BS, of which 22,805 were propensity-matched to controls (11,340 Hispanic). Mean patient age was 45 years and 70% were female. The prevalence of BS in Hispanics was 21/100,000 persons (281/100,000 admissions) compared to 36/100,000 persons (337/100,000 admissions) of all other ethnicities. On multivariate analysis, Hispanic patients displayed adjusted propensity-matched odds of 0.88 (p<0.01) of having BS when compared to all other admitted ethnicities. All outcomes are displayed in Table 1. There was no difference in odds of subtype of surgery when compared to non-Hispanics. For secondary outcomes, Hispanics did not display different odds of mortality, morbidity, hospital LOS or resource utilization compared to non-Hispanics.
Conclusions
Despite higher obesity rates compared to other ethnic groups, the use of bariatric surgery is lower in Hispanics, which coincides with findings from smaller studies. This may suggest the presence of ethnic disparities such as access to bariatric surgery. For those who underwent bariatric surgery, no significant difference in inpatient mortality, morbidity and resource utilization was observed when compared to other ethnicities, further illustrating that the factors affecting the use of bariatric surgery in Hispanics do not relate to the patient's inpatient clinical course, but rather due to healthcare access, personal beliefs, socioeconomic or other cultural factors.
Table 1
| Variable | Hispanics | All Other Ethnicities | | Prevalence (per 100,000 persons) | 21 | 36 | | Bariatric Surgery (per 100,000 admissions) | 281 | 337 | | Variable | Adjusted Means | 95% CI | p-value | | Additional Hospital Costs | $1,848 | -$2073 - $5,770 | 0.36 | | Additional Hospital Charges | $14,504 | -$2,404 - $31,413 | 0.09 | | Additional Length of Stay (days) | 0.3 | -0.9 - 1.5 | 0.60 | | Variable | Adjusted Odds Ratio | 95% CI | p-value | Bariatric Surgery Overall
RYGB
Sleeve Gastrectomy
Band
| 0.88
0.97
0.84
0.93 | 0.78 - 0.99
0.82 - 1.14
0.52 - 1.36
0.65 - 1.33 | 0.03
0.71
0.49
0.68 | | Mortality | 1.01 | 0.56-1.82 | 0.97 | | Shock | 0.65 | 0.44-0.97 | 0.13 | | ICU | 0.86 | 0.64-1.15 | 0.32 | | TPN | 0.87 | 0.64-1.20 | 0.40 | | CT Abdomen | 2.55 | 0.84-7.77 | 0.09 | | Abdominal Ultrasound | 2.31 | 0.85-6.32 | 0.10 | | Multi-Organ Failure | 0.83 | 0.63-1.10 | 0.19 |
Table 1 - Prevalence, resource utilization, odds of bariatric surgery, inpatient mortality and morbidity of admitted Hispanic patients compared to all other ethnicities. Abbreviation: RYGB=Roux-en-Y Gastric bypass.
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