Ethnic Disparities in Use of Bariatric Surgery in the USA: the Experience of Native Americans
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ORIGINAL CONTRIBUTIONS
Ethnic Disparities in Use of Bariatric Surgery in the USA: the Experience of Native Americans Ibrahim Al-Sumaih 1,2 & Nga Nguyen 1 & Michael Donnelly 1 & Brian Johnston 1,3 & Zhamak Khorgami 4,5 & Ciaran O’Neill 1
# The Author(s) 2020
Abstract Purpose To examine disparities in use of bariatric surgery in the USA with particular focus on the experience of Native Americans. Materials and Methods Multivariable logistic regression models were applied to the hospital discharge HCUP-NIS dataset (2008–2016) in order to examine the influence of ethnicity in use of bariatric surgery while controlling for aspects of need, predisposing and enabling factors. Separate models investigated disparities in length of stay, cost and discharge to healthcare facility among patient episodes for bariatric surgery. Results Full data for 1,729,245 bariatric surgery eligible participants were extracted from HCUP-NIS. The odds of Native Americans receiving bariatric surgery compared to White Americans were 0.67 (95% CI, 0.62–0.73) in a model unadjusted for covariates; 0.65 (95% CI, 0.59–0.71) in a model adjusted for demography and insurance; 0.59 (95% CI, 0.54–0.64) in a model adjusted for clinical variables; and 0.72 (95% CI, 0.66–0.79) in a model adjusted for demographic, insurance types and clinical variables. Native Americans who underwent surgery had significantly shorter lengths of stay, lower healthcare expenditures and lower likelihood of discharge to other healthcare facilities relative to White Americans (controlling for covariates). Conclusion Our study, the first study to examine this subject, showed apparent variations in receipt of bariatric surgery between Native Americans and White Americans even after a range of covariates were controlled. In addition, Native Americans have shorter lengths of stay and significantly lower expenditures. Keywords Bariatric surgery . Obesity . Ethnic groups . Health expenditure . Insurance . Length of stay . American Indians
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04529-w) contains supplementary material, which is available to authorized users. * Ciaran O’Neill [email protected] 1
Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen’s University Belfast, Block B, Royal Victoria Hospital, Belfast BT12 6BA, UK
2
Ministry of Health, Riyadh, Saudi Arabia
3
Belfast Health and Social Care Trust, Belfast, UK
4
Department of Surgery, College of Medicine, University of Oklahoma, Tulsa, OK, USA
5
Harold Hamm Diabetes Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
Introduction There is a significant economic burden associated with obesity that includes the cost of managing the condition and associated co-morbidities [1], its impact on health-related quality of life HRQoL [2] and its impact in terms of lost productivity [3]. These costs have risen as the prevalence of obesity has increased. In the USA,
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