Beyond insurance: race-based disparities in the use of metabolic and bariatric surgery for the management of severe pediatric obesity

Perez, Numa P.; Westfal, Maggie L.; Stapleton, Sahael M.; Stanford, Fatima Cody; Griggs, Cornelia L.; Pratt, Janey; Chang, David C.; Kelleher, Cassandra M.

doi:10.1016/j.soard.2019.11.020

Cited by 39 publications

(22 citation statements)

References 18 publications

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“…With this shift in policy comes an even greater role for pharmacotherapy treatment as prior studies have found that AOMs serve as a useful adjunct in postsurgical patients following bariatric surgery to treat inadequate WL or weight regain (49)(50)(51)(52)(53). Unfortunately, there also remain significant barriers to MBS for the management of pediatric obesity relating to racial disparities in that white adolescents are more likely to undergo MBS despite higher rates of obesity existing amongst black and Hispanic youth (54).…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

et al. 2020

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Lifestyle modifications focused on diet, physical activity, and behavior have a modest impact on weight reduction in children, adolescents, and young adults (YA) with overweight and obesity. Several anti-obesity medications (AOMs) have been approved by the Food and Drug Administration (FDA) for use among adult patients with a body mass index (BMI) ≥27 kg/m 2 and at least one obesity-related illness. However, only two FDA-approved AOMs are available for use in children and adolescents, which leads to the frequent off-label use of adult AOMs among this population. We sought to investigate current prescribing patterns of AOMs from school age through to young adulthood in a large unified health system. Using a centralized clinical data registry containing the health data of ∼6.5 million patients, individuals aged 5-25 years old with overweight and obesity who were taking one of eight commonly prescribed AOMs from 2009 to 2018 were extracted. A total of 1,720 patients were identified, representing 2,210 medication prescribing instances. The cohort was further stratified as children (5-12 years old), adolescents (13-18 years old), and YA (19-25 years old). The mean BMI at the time of medication initiation was 34.0, 39.1, and 39.6 kg/m 2 , respectively, which corresponded to a BMI z-score (BMIz) of 2.4 and 2.3 for children and adolescents, respectively. Metformin was the most commonly prescribed medication across all ages, including off-label use for weight-loss among children and adolescents. The most commonly off-label prescribed AOM among YA was topiramate. Multivariable analyses demonstrated phentermine was the most effective AOM, with a 1.54% total body weight among YA (p = 0.05) and a 0.12 decrease in BMIz among adolescents (p = 0.003) greater final weight loss when compared to the respective overall frequency-weighted means. Our study demonstrates a statistically significant weight loss among adolescents and young adults on select pharmacotherapy. The small magnitude of this effect should Czepiel et al. Pharmacotherapy for Weight Reduction in Pediatrics be interpreted carefully, as it is likely an underestimate in the absence of a true control group. Pharmacotherapy should therefore be considered in conjunction with other multimodal therapies such as lifestyle modification and metabolic and bariatric surgery when treating overweight and obesity.

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Section: Discussionmentioning

confidence: 99%

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

et al. 2020

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“…To fully examine the impact race may have on pre-operative comorbidities and outcomes for bariatric surgery it is important that other factors be considered [24]. For example, significant components in these types of studies may relate to the availability of access to healthcare, and bariatric surgery specifically, as well as socioeconomic, psychological variables, rural vs urban residency, differences in referral for bariatric surgery, and insurance status, but these are not available for analysis in the MBSAQIP dataset [6,7,[24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Bariatric Surgery in African Americans: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Data Registry

et al. 2020

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Background The incidence of obesity is disproportionally high in African Americans (AA) in the United States. This study compared outcomes for AA patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) with non-AA patients. Methods The MBSAQIP database was reviewed for RYGB and SG patients (2015-2017). Patients were identified as AA or non-AA and grouped to RYGB or SG. Combined and univariate analyses were performed on unmatched/propensity matched populations to assess outcomes. Results After applying exclusion criteria, 75,409 AA and 354,305 non-AA patients remained. Univariate analysis identified AA-RYGB and AA-SG patients were heavier and younger than non-AA patients. Overall, AA patients tended to have fewer preoperative comorbidities than non-AA patients with the majority of AA comorbidities related to hypertension and renal disease. Analysis of propensity matched data confirmed AA bariatric surgery patients had increased cardiovascular-related disease incidence compared with non-AA patients. Perioperatively, AA-RYGB patients had longer operative times, increased rates of major complications/ICU admission, and increased incidence of 30-day readmission, re-intervention, and reoperation, concomitant with lower rates of minor complications/superficial surgical site infection (SSI) compared with non-AA patients. For SG, AA patients had longer operative times and higher rates of major complications and 30-day readmission, re-intervention, and mortality, coupled with fewer minor complications, superficial/organ space SSI, and leak. Conclusion African American patients undergoing bariatric surgery are younger and heavier than non-AA patients and present with different comorbidity profiles. Overall, AAs exhibit worse outcomes following RYGB or SG than non-AA patients, including increased mortality rates in AA-SG patients.

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“…Race and insurance status are among the most common variables associated with healthcare disparities (18,19). These ndings have been previously reported in different settings and conditions (20,21). Sharp et al demonstrated that African American patients undergoing the creation of an intestinal stoma had a higher complication rate and a longer LOS than Caucasian patients (22).…”

Section: Discussionmentioning

confidence: 75%

Permanent Stoma: A Quality Outcome in Treatment of Rectal Cancer and Its Impact on Length of Stay

Lemini

Jabbal

Stanek

et al. 2021

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Background This study aimed to identify socioeconomic predictors of permanent stoma in rectal cancer treatment and examine its association with length of stay at the treatment facility.MethodsRectal cancer patients were identified from the Agency for Health Care Administration Florida Hospital Inpatient Discharge Dataset. Multivariate regression models were utilized to identify demographic, and socioeconomic factors associated with receiving a permanent stoma as well as the associated length of stay of these patients.ResultsOf 2,630 rectal cancer patients who underwent surgery for rectal cancer, 21% had a permanent stoma. The odds of receiving permanent stoma increased with higher Elixhauser score, metastatic disease, residing in Southwest Florida, and having Medicaid insurance or no insurance/self-payers (p<0.05). Patients with a permanent stoma had a significantly extended stay after surgery (p<0.001). ConclusionsPatients with a permanent stoma following cancer resection were more likely to have open surgery, had more comorbidities, and had a longer length of stay. Additionally, the payer type significantly affected the length of stay and odds of receiving a permanent stoma.

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Beyond insurance: race-based disparities in the use of metabolic and bariatric surgery for the management of severe pediatric obesity

Cited by 39 publications

References 18 publications

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

Outcomes of Bariatric Surgery in African Americans: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Data Registry

Permanent Stoma: A Quality Outcome in Treatment of Rectal Cancer and Its Impact on Length of Stay

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