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Access to surgery

Caucasians more likely to have bariatric surgery

Six out of every thousand eligible white women had bariatric surgery compared with three out of every thousand eligible black women.

Eligible white patients are twice as likely to have bariatric surgery compared with black patients, according to research published in the American Journal of Gastroenterology. The study researchers claim the discrepancy is partly the result of differences in insurance coverage.

"Our new findings suggest that differences in insurance coverage are part of the reason why black Americans are less likely to have bariatric surgery, but it may not be the whole story,” said study co-author, Dr Sonia Saxena from the School of Public Health at Imperial College London. “We need more research to look at whether cultural differences, perhaps a greater acceptance of obesity, lack of awareness of the risks or mistrust of doctors, might also be contributing."

The study, by researchers at the Medical University of South Carolina and Imperial College London, UK, examined national trends in bariatric surgery for adults in the US from 1999 to 2010, focusing on differences in utilisation by race and access to health care.

The primary outcome measures included population-based estimates and comparison of blacks and whites eligible for surgery with those who actually received it.

They found that a higher percentage of black than white women and of black than white men were eligible for bariatric surgery. However, a higher proportion of eligible white women and men than black women and men received bariatric surgery.

A total of 69.8% of eligible white women and 72.9% of white women who received bariatric surgery had private health insurance, compared with 49.9% and 71.1% of black women.

In addition, 71.4% of eligible white men and 75.9% of white men who received bariatric surgery had private health insurance, compared with 52.4% and 74.7% of black men.

Among men eligibility and surgery rates were lower than for women of the same race, and significant differences were found by race in the same directions as for women. The figures translate as around six out of every thousand eligible white women had bariatric surgery compared with three out of every thousand eligible black women. Two out of every thousand eligible white men had bariatric surgery compared with one out of every thousand eligible black men.

"Bariatric surgery has been shown to be an effective treatment for moderate to clinically severe obesity and more importantly is has the benefit of successfully resolving or improving the important chronic conditions of diabetes and hypertension in the majority of cases," said Dr Arch G Mainous III, from the Medical University of South Carolina.

Given these estimates and study results, Mainous and his colleagues suggest the following summary of potential causes of this disparity, including:

  • access-to-care issues due to differences ininsurance coverage
  • persistent lack of trust by blacks of physicians
  • differences in how blacks and whites assess surgical risks
  • some cultural evidence of acceptance of obesity in black populations

"Bariatric surgery can improve quality of life, decrease the risk of premature death, and lower disability and health-care costs,” added Mainous. “Consequently, this health disparity in treatment has implications for health care costs and morbidity due to common diseases like diabetes and hypertension, conditions that are highly prevalent in the African American community."

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