Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018.
Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018.
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DOI：
10.1097/sla.0000000000004493
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发表时间：
2022-08-01
影响因子：
9
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II类肥胖（120%≥体重指数[BMI] <年龄和性别第95百分位数的140%）和III类肥胖（BMI≥年龄和性别第95百分位数的140%）是美国儿科人群中增长最快的肥胖亚类别。代谢和减肥手术（MBS）是一种安全有效的治疗II/III类肥胖的选择。本分析的主要目的是确定(1)目前美国II/III级肥胖患者的MBS使用率；(2)使用率和术后30天的预后。2015年至2018年全国健康与营养检查调查的横断面数据（N = 19,225）产生了美国II/III级肥胖患病率估计。2015年至2018年代谢和减肥手术认证和质量改进计划（MBSAQIP）纵向（30天）队列数据用于比较青少年和成人（N = 748,622）术后结果并计算利用率。使用MBSAQIP数据（分子）和国家健康与营养检查调查数据（分母）计算2015 - 2018年青年和成人MBS利用率。进行双样本比例检验，比较按年龄、种族和性别划分的MBS使用率和每1000人表示的MBS使用率。MBSAQIP分析样本的平均年龄分别为青年17.9（1.15）岁（n = 3846）和成人45.1（11.5）岁（n = 744,776），多数为女性（分别为77.4%和80.7%）和非西班牙裔白人（分别为68.5%和59.4%）。2015年至2018年，年轻人的MBS使用率为1.81 / 1000，成年人为5.56 / 1000 （P < 0.001）。成人患者的再入院率（4.2%）略高于青年患者（3.4%,P = 0.01），但没有其他mbs后并发症的差异。从2015年到2018年，美国青少年II/III级肥胖在西班牙裔和非西班牙裔黑人中增加（P趋势<0001），但在完成MBS的年轻人中，非西班牙裔白人的使用率（45.8%）高于西班牙裔（22.7%）和非西班牙裔黑人（14.2%）（P = 0.006）。MBS是一种未被充分利用的肥胖治疗工具，无论是对年轻人还是成年人，尤其是少数民族群体。
Class II (120% ≥ body mass index [BMI] < 140% of the 95th percentile for age and sex) and Class III (BMI ≥140% of the 95th percentile for age and sex) obesity are the fastest growing subcategories of obesity in the United States pediatric population. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for class II/III obesity. The primary objectives of this analysis were to determine the (1) current US MBS utilization rates in those with class II/III obesity and (2) utilization rates and 30-day postoperative outcomes. The 2015 to 2018 National Health and Nutrition Examination Survey cross-sectional data (N = 19,225) generated US class II/III obesity prevalence estimates. The 2015 to 2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) longitudinal (30 days) cohort data were used to compare adolescent and adult (N = 748,622) postoperative outcomes and to calculate utilization rates. The 2015 to 2018 youth and adult MBS utilization rates were calculated using MBSAQIP data (numerator) and National Health and Nutrition Examination Survey data (denominator). Two-sample tests of proportions were performed to compare the MBS utilization rates by age, ethnicity, and sex and expressed per 1000. Mean age of the analytical MBSAQIP sample was 17.9 (1.15) years in youth (n = 3846) and 45.1 (11.5) in adults (N = 744,776), majority female (77.4%, 80.7%, respectively) and non-Hispanic White (68.5%, 59.4%, respectively). The overall 2015 to 2018 MBS utilization rate for youth was 1.81 per 1000 and 5.56 per 1000 for adults (P < 0.001). Adult patients had slightly higher percentage (4.2%) of hospital readmissions compared to youth (3.4%, P = 0.01) but there were no other post-MBS complication differences. From 2015 to 2018 the US prevalence of youth with class II/III obesity increased in Hispanics and non-Hispanic Blacks (P trend <0001), but among youth who did complete MBS non-Hispanic Whites had higher rates of utilization (45.8%) compared to Hispanics (22.7%) and non-Hispanic blacks 14.2% (P = 0.006). MBS is an underutilized obesity treatment tool for both youth and adults, and among ethnic minority groups in particular.