title: A population-based analysis of use and outcomes of laparoscopic bariatric surgery across socioeconomic groups in Taiwan.
abstract: BACKGROUND
  With the growing development of minimally invasive techniques for the treatment of morbid obesity, laparoscopic bariatric surgery (LBS) is increasingly performed. This study aimed to assess the association between patients' socioeconomic status (SES) and the likelihood of undergoing LBS and related outcomes in Taiwan.
  
  
  METHODS
  This nationwide population-based study was conducted by using data from Taiwan's National Health Insurance Research Database. A total of 3678 morbidly obese patients aged 18 years and older who underwent conventional open bariatric surgery or LBS were identified between 2004 and 2011. Regression analyses were performed using generalized estimating equation (GEE) models to account for the nesting of patients within physician to assess patients' SES category associated with the use of LBS and related outcomes. Odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated.
  
  
  RESULTS
  Compared with those with medium and low SES (84.6 % and 80.2 %), patients with high SES (88.1 %) had the highest percentage of undergoing LBS (P < 0.001). After adjusting for patient demographics, institution and surgeon characteristics, the multivariate GEE analysis revealed that the highest likelihood of undergoing LBS was noted in morbidly obese patients with high SES (OR = 1.45, 95 % CI 1.10-1.90), followed by those with medium SES (OR = 1.27, 95 % CI 1.04-1.56). In addition, patients with high SES had slightly lower length of hospital stay (LOS; OR = 0.90, 95 % CI 0.82-0.99) and hospital treatment cost (OR = 0.93, 95 % CI 0.87-0.99) than their counterparts after adjustment.
  
  
  CONCLUSIONS
  The increased likelihood of undergoing LBS and lower LOS and hospital treatment cost were noted among morbidly obese patients with higher SES. This finding suggests there is the need to improve clinical practice and reduce health disparities in the surgical treatment of morbidly obese patients.
authors.affiliation: Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan. huangmtc@gmail.com.
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Master Degree Program in Aging and Long-Term Care, College of Nursing, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, Taiwan. yah@kmu.edu.tw.|Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi, Taiwan. yah@kmu.edu.tw.
authors.forename: Yu-Tung
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Department of General Surgery, Chi Mei Medical Center, Tainan, Liouying, Taiwan. chiuchongchi@yahoo.com.tw.|Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan. chiuchongchi@yahoo.com.tw.
authors.forename: Chong-Chi
authors.initials: CC
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery / Q000592:standards* / Q000706:statistics & numerical data; D018672:Community Health Planning / Q000592:standards*; D003710:Demography; D005260:Female; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology