Socioecological Factors Associated With Ethnic Disparities In Bariatric Surgery Utilization - DEIA Mentorship Supplement

项目摘要 代谢和减肥手术(MBS)是治疗严重肥胖症的安全和有效的医学选择。然而， 尽管(1)美国每年进行的住房抵押贷款证券化程序的数量有所增加，以及(2) 事实上，很多人表示对按揭证券感兴趣，只有约50%的获转介或合资格申请按揭证券的人士实际上 接受这一程序。此外，研究还记录了西班牙裔和非西班牙裔黑人(NHB)是 与非西班牙裔白人(NHW)相比，完成MBS的可能性要低得多，尽管两者的严重程度都较高 肥胖及与肥胖相关的并发症(如2型糖尿病、心脏病、癌症)。种族问题的原因 MBS后体重减轻和共病解决方面的群体差异在很大程度上是未知的；因此， 正在进行以下目标：目标1.确定与 以下四个由患者决定的MBS组：(1)早期MBS完成者(&lt；3个月)，(2)晚期完成者 MBS(3个月，但在12-15个月内)，(3)MBS的非完全性患者，因为手术是选择性的 预定后取消；以及(4)在收到体检报告后因对住房抵押贷款证券不感兴趣而未完成的 转介。目标2：确定第1组和第2组的差异与术后体重减轻和合并症的关系 在MBS后6个月、12个月和24个月时解决。目标3.探索种族的中介和调节作用， MBS承诺组的个人、人际、临床和其他环境交互作用 不同之处。对于这一行政补充，我们建议在一年内(1)加强我们现有的母公司 与另外两个子项目进行研究，第一个由我们目前的博士后研究员(艾丽莎·莫拉莱斯博士- Marroquín)题为MBS和种族在血液和肠道微生物群与 第二个由我们的临床合作者(Jaime Almandoz博士)领导，标题为深入探索 不同种族患者对MBS完成和MBS后体重减轻的耻辱和偏见 有自己的一套具体目标；(2)从Deia增加两个研究生研究助理培训名额 为Morales Marroquín博士和Almandoz博士的项目提供帮助的背景；(3)加强当前 指导基础设施，以扩大我们的本科生暑期奖学金计划；和(4)利用家长 R01是成功的团队科学的一个例子。这些目标将惠及教职员工、博士后、研究生、 和本科培养水平，并将在家长的带领下，通过各级推广点对点辅导 格兰特首席调查员。总而言之，家长奖到目前为止产生了有影响力的工作，这是在通知 在大流行后恢复工作中对MBS患者的临床护理。我们的父母助学金就是一个很好的例子 团队、跨学科科学和代表流行病学、外科、精神病学的科学家， 内分泌学和肥胖医学可以成功地合作，产生有效的结果，以改善 弱势群体的健康。在这里，我们建议继续强调跨学科，通过一个 基础/临床科学分项目和一个临床/公共卫生分项目。

PROJECT ABSTRACT Metabolic and bariatric surgery (MBS) is a safe and medically effective treatment choice for severe obesity. Yet, despite (1) an increase in the number of MBS procedures performed in the United States annually, and (2) the fact that many people express interest in MBS, only about 50% of referred or eligible persons for MBS 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 MBS despite higher rates of both severe obesity and obesity-related comorbidities (e.g. type 2 diabetes, heart disease, cancer). Reasons for the ethnic group disparities in post-MBS weight loss and comorbidity resolution are largely unknown; therefore, the following aims are being conducted: AIM 1. Identify the socioecological characteristics associated with the following four patient-determined MBS groups: (1) early-completers of MBS (< 3 months), (2) later-completers of MBS (>3 months but within 12-15 months), (3) non-completers of MBS because surgery was electively cancelled after being scheduled; and (4) non-completers due to no interest in MBS after receiving a medical referral. 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- MBS. AIM 3. Explore the mediating and moderating effect of ethnicity, intrapersonal, interpersonal, clinical, and other environmental interactions on MBS commitment group differences. For this administrative supplement we are proposing over 1 year to (1) enhance our current parent study with two additional sub-projects, the first one led by our current postdoc fellow (Dr. Elisa Morales- Marroquín) titled Role of MBS and Ethnicity on the Relationship Between the Blood and Gut Microbiotas and the second led by our clinical collaborator (Dr. Jaime Almandoz) titled An In-Depth Exploration of the Impact of Weight Stigma and Bias on MBS Completion and Post-MBS Weight Loss in Ethnically Diverse Patients, each with their own set of specific aims; (2) add two additional graduate research assistant training slots from DEIA backgrounds to assist Drs. Morales Marroquín and Almandoz with their projects; (3) enhance the current mentoring infrastructure to expand our Summer Scholars Program for undergraduates; and (4) use the parent R01 as an example of successful team science. These goals will reach trainees at the faculty, postdoc, graduate, and undergraduate training level and will promote peer-to-peer mentoring through all levels, led by the parent grant Principal Investigator. In summary, the parent award has produced impactful work to date that is informing clinical care for MBS patients in post-pandemic recovery efforts. Our parent grant provides an excellent example of how team, interdisciplinary science, and scientists representing epidemiology, surgery, psychiatry, endocrinology, and obesity medicine can successfully collaborate to produce impactful outcomes to improve the health of vulnerable populations. Here we propose to continue with that interdisciplinary emphasis via one basic/clinical science sub-project and one clinical/public health sub-project.