Sex, Race, and Consideration of Bariatric Surgery Among Primary Care Patients with Moderate to Severe Obesity
Sex, Race, and Consideration of Bariatric Surgery Among Primary Care Patients with Moderate to Severe Obesity
复制标题
DOI：
10.1007/s11606-013-2603-1
复制
发表时间：
2014-01-01
影响因子：
5.7
通讯作者：
Hamel, MaryBeth
中科院分区：
文献类型：
--
作者：
Wee, Christina C.;Huskey, Karen W.;Hamel, MaryBeth
减肥手术是为数不多的能够显著减轻体重的肥胖治疗方法之一，但只有一小部分符合医疗条件的患者，尤其是男性和少数族裔，接受了减肥手术。描述初级保健患者对减肥手术的考虑，性别和种族的潜在差异，以及任何差异背后的因素。电话访问了337名身体质量指数（BMI）为35 kg/m(2)的患者，他们在大波士顿地区的四个不同的初级保健诊所就诊。患者对减肥手术的考虑。在325名听说过减肥手术的患者中，34%的人认真考虑过手术。在调整了社会人口统计学和BMI后，男性比女性更不可能考虑手术，非裔美国人比白人患者更不可能考虑手术。合并症不能解释性别和种族差异，但在调整生活质量（QOL）后，种族差异消失，非裔美国人的合并症往往高于白人患者。医生推荐的减肥手术与认真考虑手术独立相关[OR 4.95 (95% CI 2.81-8.70)]，但不能解释不同性别和种族的手术考虑差异。然而，如果他们的医生建议，男性和非裔美国人和西班牙裔患者在调整后更愿意考虑减肥手术。然而，只有20%的患者报告他们的医生建议进行减肥手术，非裔美国人和男性不太可能接受这种建议；推荐手术的种族差异在很大程度上也可以用生活质量的差异来解释。对减肥手术的高感知风险是最常被提及的障碍；财务方面的担忧很少被提及。单一地理区域；检查考虑，而不是谁最终进行了减肥手术。非裔美国人和男性不太可能考虑减肥手术，也不太可能被医生推荐手术。肥胖如何影响生活质量的差异似乎解释了其中的一些差异。对患者来说，最大的阻碍是高感知风险，而不是经济障碍。
Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery.To describe primary care patients' consideration of bariatric surgery, potential variation by sex and race, and factors that underlie any variation.Telephone interview of 337 patients with a body mass index or BMI > 35 kg/m(2) seen at four diverse primary care practices in Greater-Boston.Patients' consideration of bariatric surgery.Of 325 patients who had heard of bariatric surgery, 34 % had seriously considered surgery. Men were less likely than women and African Americans were less likely than Caucasian patients to have considered surgery after adjustment for sociodemographics and BMI. Comorbid conditions did not explain sex and racial differences but racial differences dissipated after adjustment for quality of life (QOL), which tended to be higher among African American than Caucasian patients. Physician recommendation of bariatric surgery was independently associated with serious consideration for surgery [OR 4.95 (95 % CI 2.81-8.70)], but did not explain variation in consideration of surgery across sex and race. However, if recommended by their doctor, men were as willing and African American and Hispanic patients were more willing to consider bariatric surgery than their respective counterparts after adjustment. Nevertheless, only 20 % of patients reported being recommended bariatric surgery by their doctor and African Americans and men were less likely to receive this recommendation; racial differences in being recommended surgery were also largely explained by differences in QOL. High perceived risk to bariatric surgery was the most commonly cited barrier; financial concerns were uncommonly cited.Single geographic region; examined consideration and not who eventually proceeded with bariatric surgery.African Americans and men were less likely to have considered bariatric surgery and were less likely to have been recommended surgery by their doctors. Differences in how obesity affects QOL appear to account for some of these variations. High perceived risk rather than financial barrier was the major deterrent for patients.