Socioecological Factors Associated with Ethnic Disparities in Bariatric Surgery Utilization

减肥/代谢手术或减肥手术（WLS）不仅在传统的生活方式改变方法（减少热量摄入，增加活动水平）失败时成为越来越多使用的肥胖治疗选择，而且也是严重肥胖的安全和医学有效的治疗选择。然而，尽管每年在美国进行的WLS程序的数量增加，而且许多人对WLS表示兴趣，但只有大约50%的WLS推荐或符合条件的人实际接受了该程序。此外，研究证明，尽管严重肥胖和肥胖相关合并症（例如2型糖尿病、心脏病）的发生率较高，但西班牙裔和非西班牙裔黑人（NHB）完成WLS的可能性明显低于非西班牙裔白人（NHW）。WLS后体重减轻和合并症解决的种族差异的原因在很大程度上是未知的;该领域尚未探索 种族群体特定信仰、行为和传统对术前WLS完成时间表或术后体重减轻和合并症结局的影响。我们将通过以下目的检查WLS患者的社会生态因素（社会，文化，临床和其他环境支持）的短期（6个月），中期（12个月）和长期（24个月）影响：AIM 1。确定与以下四个患者确定的WLS组相关的社会生态学特征：（1）WLS早期完成者（< 3个月），（2）WLS晚期完成者（>3个月但在12-15个月内），（3）由于手术在计划后被选择性取消而导致的WLS非完成者;（4）由于接受医疗转诊后对WLS不感兴趣而导致的非完成者。AIM 2.患者的社会生态因素（社会，通过以下目的：AIM 2.确定第1组和第2组中的差异如何与WLS后6- 12个月和24个月的术后体重减轻和合并症消退相关。AIM 3.探讨族群、工作生活承诺对群体差异的中介交互作用及调节效应。自我、人际、临床和其他环境相互作用对WLS承诺组差异的影响。将使用分类和回归树（CART）技术和标准多元回归分析的联合统计方法（2阶段）对术前社会生态学和人口统计学变量的影响进行建模（包括种族）作为承诺/完成小组成员资格的判别因素（目标1），并且确定在对由CART解决方案产生的术前鉴别器进行调整之后的组成员资格与术后鉴别器之间的关系。手术社会生态学特征和对体重减轻的影响（目的2）。

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).