Low socioeconomic status is associated with lower weight-loss outcomes 10-years after Roux-en-Y gastric bypass.
Bariatric
Long-term outcomes
Roux-en-y Gastric Bypass (RYGB)
Socioeconomic status
Veterans Affairs (VA)
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
30
03
2018
accepted:
29
06
2018
pubmed:
11
7
2018
medline:
18
2
2020
entrez:
11
7
2018
Statut:
ppublish
Résumé
Roux-en-Y gastric bypass (RYGB) is the criterion standard operation for weight loss. Low socioeconomic status (SES) is common in the Veteran population undergoing bariatric surgery, but the impact of SES on long-term weight-loss outcomes is not known. We hypothesize that low socioeconomic status is associated with less weight loss after gastric bypass in long-term follow-up. We performed a retrospective review of patients undergoing RYGB at a single Veterans Affairs (VA) hospital. Patients with at least 10 years of follow-up data in the electronic health record were included in the analysis. Weight loss was measured as percent excess body mass index loss (%EBMIL). The primary predictor variable, median household income, was determined using zip codes of patient residences matched to publicly available 2010 U.S. census data. Univariate relationships between income, weight loss, and other patient characteristics were evaluated. We calculated a multivariate generalized linear model of %EBMIL to estimate independent relationships with median household income quartile while controlling for patients' age, race, sex, and VA distance. Complete 10-year follow-up data were available for 83 of 92 patients (90.2%) who underwent RYGB between 2001 and 2007 and survived at least 10 years. The majority of patients were male (79.5%) and white (73.5%). The mean 10-year %EBMIL was 57.8% (SD: 29.5%, range - 36.0% - 132.8%). In univariate analysis, income was significantly associated with race (p < 0.001) and median distance to the VA bariatric center (p = 0.034), but income did not differ by gender (p = 0.73) or age (p = 0.45). Multivariate analysis revealed significantly lower 10-year %EBMIL for patients with the lowest income compared to patients with low-mid income (p = 0.03) and mid-high income (p = 0.01), after controlling for gender, race, age, and VA distance. Low socioeconomic status is associated with lower weight-loss outcomes, 10 years after RYGB. Durable weight loss is observed in all income groups.
Sections du résumé
BACKGROUND
Roux-en-Y gastric bypass (RYGB) is the criterion standard operation for weight loss. Low socioeconomic status (SES) is common in the Veteran population undergoing bariatric surgery, but the impact of SES on long-term weight-loss outcomes is not known. We hypothesize that low socioeconomic status is associated with less weight loss after gastric bypass in long-term follow-up.
METHODS
We performed a retrospective review of patients undergoing RYGB at a single Veterans Affairs (VA) hospital. Patients with at least 10 years of follow-up data in the electronic health record were included in the analysis. Weight loss was measured as percent excess body mass index loss (%EBMIL). The primary predictor variable, median household income, was determined using zip codes of patient residences matched to publicly available 2010 U.S. census data. Univariate relationships between income, weight loss, and other patient characteristics were evaluated. We calculated a multivariate generalized linear model of %EBMIL to estimate independent relationships with median household income quartile while controlling for patients' age, race, sex, and VA distance.
RESULTS
Complete 10-year follow-up data were available for 83 of 92 patients (90.2%) who underwent RYGB between 2001 and 2007 and survived at least 10 years. The majority of patients were male (79.5%) and white (73.5%). The mean 10-year %EBMIL was 57.8% (SD: 29.5%, range - 36.0% - 132.8%). In univariate analysis, income was significantly associated with race (p < 0.001) and median distance to the VA bariatric center (p = 0.034), but income did not differ by gender (p = 0.73) or age (p = 0.45). Multivariate analysis revealed significantly lower 10-year %EBMIL for patients with the lowest income compared to patients with low-mid income (p = 0.03) and mid-high income (p = 0.01), after controlling for gender, race, age, and VA distance.
CONCLUSIONS
Low socioeconomic status is associated with lower weight-loss outcomes, 10 years after RYGB. Durable weight loss is observed in all income groups.
Identifiants
pubmed: 29987570
doi: 10.1007/s00464-018-6318-6
pii: 10.1007/s00464-018-6318-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
454-459Références
Das SR, Kinsinger LS, Yancy WS Jr, Wang A, Ciesco E, Burdick M, Yevich SJ (2005) Obesity prevalance among Veterans at Veterans affairs medical facilities. Am J Prev Med 28:291–294
doi: 10.1016/j.amepre.2004.12.007
pubmed: 15766618
Koepsell TD, Littman AJ, Forsberg CW (2012) Obesity, overweight, and their life course trajectories in Veterans and non-Veterans. Obesity 20:434–439
doi: 10.1038/oby.2011.2
pubmed: 21293452
Klein S, Ghosh A, Cremieux PY, Eapen S, McGavock TJ (2011) Economic impact of the clinical benefits of bariatric surgery in diabetes patients with BMI> = 35 kg/m. Obesity (Silver Spring) 19:581–587
doi: 10.1038/oby.2010.199
Neovius M, Narbro K, Keating C, Peltonen M, Sjoholm K, Agren G, Sjostrom L, Carlsson L (2013) Health care use during 20 years following bariatric surgery. JAMA 308:1132–1141
doi: 10.1001/2012.jama.11792
Fouse T, Schauer P (2016) The socioeconomic impact of morbid obesity and factors affecting access to obesity surgery. Surg Clin North Am 96:669–679
doi: 10.1016/j.suc.2016.03.002
pubmed: 27473794
Bhogal SK, Reddigan JI, Rotstein OD, Cohen A, Glockler D, Tricco A, Smylie JK, Glazer SA, Pennington J, Conn LG, Jackson TD (2015) Inquity to the utilization of bariatric surgery: a systematic review and metaanalysis. Obes Surg 25:888–899
doi: 10.1007/s11695-015-1595-9
pubmed: 25726318
Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, Gutierrez JM, Frogley SJ, Ibele AR, Brinton EA, Hopkins PN, McKinlay R, Simper SC, Hunt SC (2017) Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med 371:1143–1155
doi: 10.1056/NEJMoa1700459
National Center for Veterans Analysis and Statistics (2015) Veteran poverty trends. United States Department of Veteran Affairs, Washington, DC
Chai W, Fan JX, Wen M (2018) Association of individual and neighborhood factors with home food availability: evidence from the National Health and Nutrition Examination Survey. J Acad Nutr Diet 118(5):815–823
doi: 10.1016/j.jand.2017.11.009
pubmed: 29396154
pmcid: 5924612
O’Donaghue G, Kennedy A, Puggina A, Aleksova K, Buck C, Burns C, Cardon G, Carlin A, Ciarapica D, Colotto M, Condello G, Coppinger T, Cortis C, D’Haese S, De Craemer M, Di Blasio A, Hansen S, Iacoviello L, Issartel J, Izzicupo P, Jaeschke L, Kanning M, Ling F, Luzak A, Napolitano G, Nazare J, Perchoux C, Pesce C, Pischon T, Polito A, Sannela A, Schulz H, Simon C, Sohun R, Steinbrecher A, Schlicht W, MacDonncha C, Capranica L, Boccia S (2017) Socio-economic determinants of physical activity across the life course: a “determinar of diet and physical activity” (DEDIPAC) umbrella literature review. PLoS ONE 13:e0190737
doi: 10.1371/journal.pone.0190737
Wallace A, Young-Xu Y, Hartley D, Weeks W (2009) Racial, socioeconomic, and rural-urban disparities in obesity-related bariatric surgery. Obes Surg 20:1354–1360
doi: 10.1007/s11695-009-0054-x
Keating C, Backholer K, Moodie M, Stevenson C, Peeters A (2015) Differences in the rates of treatment of severe obesity using bariatric surgery across socioeconomic groups. JAMA Surg 150:367–368
doi: 10.1001/jamasurg.2014.3180
pubmed: 25671559
https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml?src=bkmk
Akkary E, Nerlinger A, Yu S, Dziura J, Duffy AJ, Bell RL (2009) Socioeconomic predictors of weight loss after laparoscopic Roux-Y gastric bypass. Surg Endosc 23(6):1246–1251
doi: 10.1007/s00464-008-0138-z
pubmed: 18813989
Durkin AJ, Bloomston M, Murr MM, Rosemurgy AS (1999) Financial status dose not predict weight loss after bariatric surgery. Obes Surg 9:524–526
doi: 10.1381/096089299765552594
pubmed: 10638475
Gullick A, Graham L, Richman J, Kakade M, Stahl R, Grams J (2014) Association of race and socioeconomic status with outcomes following laparoscopic Roux-en-Y Gastric bypass. Obes Surg 25:705–711
doi: 10.1007/s11695-014-1447-z
Memarian E, Calling S, Sundquist K, Sundquist J, Li X (2014) Sociodemographic differences and time trends of bariatric surgery in Sweden 1990–2010. Obes Surg 24:2109–2116
doi: 10.1007/s11695-014-1287-x
pubmed: 24817429
pmcid: 4794251
Doumouras AG, Saleh F, Sharma AM, Anvari S, Gmora S, Anvari M, Hong D (2017) Geographic and socioeconomic factors affecting delivery of bariatric surgery across high- and low-utilization healthcare systems. Br J Surg 104:891–897
doi: 10.1002/bjs.10517
pubmed: 28376245
Birkmeyer NJ, Gu N (2012) Race, soecioeconomic status, and the use of bariatric surgery in Michigan. Obes Surg 22:259–265
doi: 10.1007/s11695-010-0210-3
pubmed: 20559894
Wallace AE, Young-Xu Y, Hartley D, Weeks WB (2010) Racial, socioeconomic, and rural-urban disparities in obesity-related bariatric surgery. Obes Surg 20:1354–1360
doi: 10.1007/s11695-009-0054-x
pubmed: 20052561