title: Racial disparities in mortality in patients undergoing bariatric surgery in the U.S.A.
abstract: BACKGROUND
  Non-Hispanic blacks bear a disproportionate burden of the growing obesity epidemic. Bariatric surgery is an effective treatment for morbid obesity. We sought to assess for racial disparities in short-term outcomes following bariatric surgery.
  
  
  METHODS
  Patients undergoing bariatric surgery were extracted from the Nationwide Inpatient Sample between 1999 and 2007. In-hospital mortality and length of stay were compared between different racial groups undergoing bariatric surgery after stratification by gender, and multivariate analysis was conducted to adjust for demographic, surgery year, and clinical and hospital characteristics.
  
  
  RESULTS
  There were 115,507 bariatric surgeries. Overall mortality rate was 2.5 deaths per 1,000 and was higher among non-Hispanic blacks compared to non-Hispanic whites (3.7 vs. 2.3 per 1,000; P = 0.007). Racial mortality disparities were most pronounced among males and at hospitals with lowest surgical volumes. In multivariate analysis, predictors of mortality were non-Hispanic black race (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.22-2.45), increasing age, increasing Charlson index (OR, 1.26; 95% CI, 1.16-1.37), Medicare (OR, 2.13; 95% CI, 1.57-2.91), and Medicaid (OR, 3.35; 95% CI, 2.29-4.91) insurance. Incremental calendar year had reduced odds of mortality (OR, 0.80; 95% CI, 0.76-0.83). Above national median neighborhood income (OR, 0.59; 95% CI, 0.42-0.83) was protective in males, while teaching hospital status conveyed greater mortality (OR, 2.12; 95% CI, 1.40-3.22).
  
  
  CONCLUSIONS
  Non-Hispanic blacks undergoing bariatric surgery demonstrate higher in-hospital mortality than their racial counterparts. It is unclear if this disparity is due to susceptibility to obesity-related mortality or suboptimal delivery of healthcare in the perioperative setting.
authors.affiliation: Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 437, Toronto, Ontario, Canada, M5G 1X5, geoff.nguyen@utoronto.ca.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
authors.forename: Akash M
authors.initials: AM
authors.lastname: Patel
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D050110:Bariatric Surgery / Q000401:mortality*; D004198:Disease Susceptibility; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009767:Obesity, Morbid / Q000208:ethnology / Q000401:mortality*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D063505:Racism; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*