Socioecological Factors Associated with Ethnic Disparities in Bariatric Surgery Utilization

减肥/代谢手术或减肥手术(WLS)不仅在传统生活方式改变方法(减少卡路里摄取，增加运动水平)失败时越来越多地被使用，而且对于严重肥胖也是一种安全和医学上有效的治疗选择。然而，尽管美国每年进行的WLS程序的数量有所增加，而且许多人表示对WLS感兴趣，但只有大约50%的转介或有资格获得WLS的人实际上接受了这种程序。此外，研究证明，尽管严重肥胖率和肥胖相关并发症(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)。种族群体在WLS后体重减轻和共病解决方面存在差异的原因在很大程度上尚不清楚；该领域尚未进行探索 种族群体特定的信仰、行为和传统对手术前完成WLS的时间框架或手术后体重减轻和共病结果的影响。我们将通过以下目的来研究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)的影响：目的1.确定与以下四个患者确定的WLS组相关的社会生态特征：(1)WLS的早期患者(3个月)，(2)WLS的晚期患者(3个月但在12-15个月内)，(3)WLS的非完全者，因为手术在预定时间后被选择性地取消；(4)在接受医疗转介后，因对WLS不感兴趣而未完成的人。目的2.患者的社会生态因素(通过以下目的)：目的2.确定第1组和第2组的差异如何与术后6-12和24个月的体重减轻和合并症消退有关。目的3.探讨种族、工作满意度承诺群体差异的中介交互作用和调节作用。个人、人际、临床和其他环境交互作用对WLS承诺组差异的影响。将使用分类和回归树(CART)和标准多元回归分析技术的组合统计方法(2阶段)来模拟作为承诺/完成组成员资格判别因素的术前社会生态和人口学变量(包括种族)的影响(目标1)，并确定由CART解决方案产生的术前判别因素调整后的组成员关系和术后社会生态概况以及对减肥的影响(目标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).