G. Ortega1,2, N. R. Changoor1, C. K. Zogg3, R. Altafi2, H. Naseem7, F. G. Qureshi5,6 1Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 2Outcomes Research Center Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 3Yale University School Of Medicine,New Haven, CT, USA 4Howard University College Of Medicine,Washington, DC, USA 5University Of Texas Southwestern Medical Center,Dallas, TX, USA 6Children’s Medical Center,Dallas, Tx, USA 7Women And Children’s Hospital Of Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA
Introduction: Despite data to suggest that weight loss surgery has the best long-term success in adolescents with complicated obesity, the number of procedures performed remains stagnant. As obesity is disproportionately prevalent in minority groups, we sought to determine if the utilization of bariatric surgery differs by socioeconomic and demographic categorization among morbidly obese adolescent patients.
Methods: We conducted a retrospective review of the 2009 and 2012 Kids Inpatient Database, selecting for adolescent patients aged 15-21y with diagnoses of morbid obesity. Differences in receipt vs. non-receipt of bariatric surgery were compared using descriptive statistics in order to assess for differences in patient demographics, socioeconomic factors, comorbid conditions, and in-hospital morbidity and mortality. Multivariable logistic regression was then used to assess for risk-adjusted differences in bariatric surgery utilization based on variations in socioeconomic and demographic parameters.
Results: A total of 27,403 adolescents with morbid obesity were identified. The majority was female (72%) with a mean age of 17±4y. A total of 1,726 patients (6%) underwent bariatric surgery. Those receiving operations were more likely to be non-Hispanic White (59 vs. 41%, p<0.001), female (77 vs. 72%, p<0.001), older (mean age 16.9 vs. 18.6y, p<0.001), of higher income (33 vs. 54%, p<0.001), and privately insured (72 vs 33%, p<0.001). Risk-adjusted analyses demonstrated that relative to non-Hispanic White patients, morbidly obese non-Hispanic Black (OR 0.45, 95%CI 0.39-0.54), Asian/Pacific Islander (0.54, 0.30-0.99) and Native American (0.43, 0.21-0.88) patients were each significantly less likely to undergo bariatric surgery. There was no difference among Hispanic patients (OR 0.99, 95%CI: 0.86-1.15). When considered by income, no differences in utilization within the lowest two incomes quartiles were found; however, patients from households in the third (OR 1.58, 95%CI 1.35-1.85) and fourth (2.34, 1.99-2.75) quartiles were each more likely to have bariatric surgery than those in the lowest income quartile. Adolescents with private insurance were markedly more likely to have bariatric surgery when compared to adolescents with public insurance (4.73, 4.18-5.36).
Conclusion: Assessment of bariatric surgery utilization among adolescents demonstrated significant differences in weight loss procedures among patients based on race/ethnicity, income and insurance status. Patients who were non-Hispanic White or Hispanic, from a higher median household income and with private insurance were more likely to undergo surgery. These findings suggest an opportunity to expand access to weight loss surgery to all adolescents who may benefit from it.