A. Lewis2, J. Tseng1, M. Burch1, A. Milam1, N. Khanna3, R. F. Alban1 1Cedars-Sinai Medical Center, Surgery, Los Angeles, CA, USA 2Western University of Health Sciences, College Of Osteopathic Medicine Of The Pacific, Pomona, CA, USA 3California Northstate University, College Of Medicine, Elk Grove, CA, USA
Introduction:
Existing literature has consistently found that lower income areas tend to have higher obesity rates given the low access to fresh produce and high number of fast food restaurants (“food deserts”). As defined by the United States Department of Agriculture (USDA), a food desert is a US census tract with a poverty rate of 20% or greater (low income), where 33% of the population live more than a mile away (low access) from a supermarket or grocery store and ultimately healthy food.
We will use the emerging findings surrounding food deserts to expound on what seems to be missing from the literature: the relationship between food deserts, bariatric surgery/obesity-related procedures, and thus, medical costs.
Methods:
The 2018 California Inpatient Database was queried for all inpatient admissions of patients ≥ 18 years old. Food deserts were identified using the USDA Food Access Research Atlas, and matched to patients via home address zip codes. Data on BMI and obesity-related procedures were obtained through ICD-10-CM and ICD-10-PCS codes. Patients living in food deserts (FD) were compared to those living in non-food deserts (non-FD). Patients with BMI≥30 (obese) were compared to those with BMI <30, and multivariable regression was used to identify predictors of obesity. In patients with BMI≥40 (morbidly obese), patients who received bariatric surgery were compared to those who did not, and multivariable regression was used to identify predictors of bariatric surgery.
Results:
A total of 3,696,877 admissions were identified, of which 321,732 (8.7%) lived in food deserts. When comparing FD to non-FD patients, FD were more likely to: be Hispanic (40.1% vs 31.5%, p<.01), live in low-income neighborhoods (lowest quartile, 69.5% vs 25.9%, p<.01), be insured with Medicaid (41.9% vs 29.6%, p<.01), have higher rates of obesity (14.2% vs 12.7%, p<.01) and less likely to be Asian (3.5% vs 10.8%, p<.01). When comparing patients with obesity to those without, patients with obesity were more likely to be female (61.5% vs 54.7% p<.01) and live in food deserts (9.7% vs 8.6%, p<.01). On multivariable regression, factors associated with higher odds of obesity include older age (OR 1.02, 95% CI 1.02-1.02), female sex (OR 1.34, 95% CI 1.33-1.35), non-White race (Black, OR 1.35, 95%CI 1.34-1.37; Hispanic, OR 1.15, 95%CI 1.14-1.16; Native American, OR 1.56, 95%CI 1.49-1.64), and food deserts (OR 1.14, 95%CI 1.12-1.15). Factors associated with higher odds of bariatric surgery include female sex (OR 1.63, 95%CI 1.55-1.71), private insurance (OR 5.05, 95%CI 4.67-5.45), self-pay (OR 1.74, 95%CI 1.39-2.17), and food deserts (OR 1.13, 95%CI 1.05-1.23).
Conclusion:
Food deserts are associated with higher rates of obesity and bariatric surgery, as well as multiple socioeconomic factors such as lower median household income, Medicaid insurance, and racial barriers affecting Hispanic, Black, and Native American races/ethnicities.