Socioecological Factors Associated with Ethnic Disparities in Bariatric Surgery Utilization

与减肥手术利用中的种族差异相关的社会生态因素

基本信息

批准号：
10559626
负责人：
Sarah Elizabeth Messiah
金额：
$ 52.01万
依托单位：
UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-16 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10559626
关键词：
Adherence Affect Appointment Bariatrics Behavior Belief Black Populations Blood Body Weight decreased Body mass index Characteristics Clinical Development Diabetes Mellitus Disparity population Education Eligibility Determination Energy Intake Ethnic Origin Ethnic Population Health Heart Diseases Hispanic Hispanic Populations Influentials Insurance Insurance Carriers Intervention Joints Life Style Mediating Medicaid Medical Metabolic Methods Mild obesity Modeling Morbid Obesity Morbidity - disease rate Non-Insulin-Dependent Diabetes Mellitus Not Hispanic or Latino Obesity Operative Surgical Procedures Outcome Patients Pattern Persons Population Postoperative Period Prevalence Principal Investigator Procedures Professional Organizations Recommendation Regression Analysis Research Personnel Resolution Risk Factors Schedule Standardization Techniques United States Universities Woman bariatric surgery cardiometabolic risk classification trees comorbidity conventional therapy diabetic effective therapy ethnic disparity ethnic diversity ethnic minority ethnic minority population follow-up healthy weight interest mortality multi-racial obese person obesity treatment patient population programs randomized, clinical trials regression trees screening social tool treatment choice uptake

项目摘要

Bariatric/metabolic surgery or weight loss surgery (WLS) has become not only an increasingly utilized obesity treatment option when conventional lifestyle change methods (decreased caloric intake, increased activity levels) fail, but also a safe and medically effective treatment choice for severe obesity. Yet, despite an increase in the number of WLS procedures performed in the United States annually, and the fact that many people express interest in WLS, only about 50 percent of referred or eligible persons for WLS actually undergo the procedure. Furthermore, studies have documented Hispanics and non-Hispanic Blacks (NHB) are significantly less likely than non-Hispanic Whites (NHW) to complete WLS despite higher rates of both severe obesity and obesity-related comorbidities (e.g. type 2 diabetes, heart disease). Reasons for the ethnic group disparities in post-WLS weight loss and comorbidity resolution are largely unknown; the field has not explored the effects of ethnic-group specific beliefs, behaviors and traditions on either pre-operative WLS completion timeframe or post-operative weight loss and comorbidity outcomes. We will examine the short (6-month)-, mid (12-months)-, and long (24-months)- term effects of WLS patients’ socioecological factors (social, cultural, clinical and other environmental-support) via the following aims: AIM 1. Identify the socioecological characteristics associated with the following four patient-determined WLS groups: (1) early-completers of WLS (< 3 months), (2) later-completers of WLS (>3 months but within 12-15 months), (3) non-completers of WLS because surgery was electively cancelled after being scheduled; and (4) non-completers due to no interest in WLS after receiving a medical referral. AIM 2. patients' socioecological factors (social, via the following aims: AIM 2. Determine how differences in Groups 1 and 2 relate to post- operative weight loss and comorbidity resolution at 6- 12- and 24-months post- WLS. AIM 3. Explore the mediating interactions on and moderating effect of ethnicity, WLS commitment group differences. intrapersonal, interpersonal, clinical and other environmental interactions on WLS commitment group differences. A combined statistical approach (2 stage) using the techniques of classification and regression trees (CART) and standard multiple regression analysis will be used to model the influences of the preoperative socioecological and demographic variables (including ethnicity) as discriminators of commitment/completion group membership (Aim 1), and to determine the relationship between group membership after adjustment for the pre-operative discriminators resulting from the CART solution and post-operative socioecological profile and the effect on weight loss (Aim 2).

减肥/代谢手术或减肥手术（WLS）（WLS）不仅成为越来越多的肥胖治疗选择，当传统的生活方式改变方法（降低热量摄入量，活动水平降低）失败，而且是严重肥胖症的安全和医学上有效的治疗选择。然而，dospite在美国年度执行的WLS程序的数量增加，许多人对WLS表示兴趣，只有大约50％的WLS转介或合格人员实际接受了该程序。此外，研究表明，尽管严重的肥胖症和与肥胖相关的合并症率较高（例如2型2型糖尿病，心脏病），但与非西班牙裔白人（NHW）相比，西班牙裔和非西班牙裔黑人（NHB）的可能性明显少于非西班牙裔白人（NHW）。 WLS减肥和合并症的种族分布的原因在很大程度上是未知的。该领域尚未探索族裔特定信念，行为和传统对术前WLS完成时间表或术后减肥和合并症结果的影响。我们将通过以下目的研究短期（6个月），中期（12个月） - 和长（24个月） - 期限的社会生态因素（社会，文化，临床和其他环境支持）的期限。后来的WLS组（> 3个月但在12-15个月内），（3）WLS的未完成者，因为手术被电气化为被安排后取消；（4）由于对WLS没有兴趣，未完成的人在接受医疗转诊后没有兴趣。 AIM 2. patients' socioecological factors (social, via the following aims: AIM 2. Determine how differences in Groups 1 and 2 relate to post-operating weight loss and comorbidity resolution at 6- 12- and 24-months post- WLS. AIM 3. Explore the mediating interactions on and moderate effect of ethnicity, WLS commitment group differences. Intrapersonal, interpersonal, clinical and other environmental interactions on WLS承诺小组的差异。使用分类和回归树（CART）和标准的多元回归分析技术的组合统计方法（2个阶段）将模拟术前的社会生态和人口统计学变量（包括种族）的影响术后的社会生态特征及其对体重减轻的影响（AIM 2）。