Bariatric surgery among vulnerable populations: The effect of the Affordable Care Act's Medicaid expansion.
Bariatric surgery among vulnerable populations: The effect of the Affordable Care Act's Medicaid expansion.
- 2019
BACKGROUND: Obesity disproportionately affects vulnerable populations. Bariatric surgery is an effective long-term treatment for obesity-related complications; however, bariatric surgical rates are lower among racial minorities and low-income and publicly insured patients. The Affordable Care Act's Medicaid expansion improved access to health insurance, but its impact on bariatric surgical disparities has not been evaluated. We sought to determine the impact of the Affordable Care Act's Medicaid expansion on disparate utilization rates of bariatric surgery. CONCLUSION: The gap in bariatric surgery rates by insurance and income was reduced after the Affordable Care Act's Medicaid expansion, but racial disparities persisted. Future research should track these trends and identify factors to reduce racial disparity in bariatric surgery. Copyright (c) 2019. Published by Elsevier Inc. METHODS: A total of 47,974 nonelderly adult bariatric surgical patients (ages 18-64 years) were identified in 2 Medicaid-expansion states (Kentucky and Maryland) versus 2 nonexpansion control states (Florida and North Carolina) between 2012 and 2015 using the Healthcare Cost and Utilization Project's State Inpatient Database. Poisson interrupted time series were conducted to determine the adjusted incidence rates of bariatric surgery by insurance (Medicaid/uninsured versus privately insured), income (high income versus low income), and race (African American versus white). The difference in the counts of bariatric surgery were then calculated to measure the gap in bariatric surgery rates. RESULTS: The adjusted incidence rate of bariatric surgery among Medicaid or uninsured and low-income patients increased by 15.8% and 5.1% per quarter, respectively, after the Affordable Care Act in expansion states (P < .001). No marginal change was seen in privately insured and high-income patients in expansion states. The adjusted incidence rates increased among African American and white patients, but these rates did not change significantly before and after the Affordable Care Act in expansion states.
English
0039-6060
10.1016/j.surg.2019.05.005 [doi] S0039-6060(19)30244-2 [pii]
*Bariatric Surgery/sn [Statistics & Numerical Data]
*Healthcare Disparities/sn [Statistics & Numerical Data]
*Obesity, Morbid/su [Surgery]
*Patient Acceptance of Health Care/sn [Statistics & Numerical Data]
*Patient Protection and Affordable Care Act/lj [Legislation & Jurisprudence]
*Vulnerable Populations/sn [Statistics & Numerical Data]
Adolescent
Adult
African Americans/sn [Statistics & Numerical Data]
Bariatric Surgery/ec [Economics]
Bariatric Surgery/lj [Legislation & Jurisprudence]
European Continental Ancestry Group/sn [Statistics & Numerical Data]
Female
Humans
Male
Medicaid/ec [Economics]
Medicaid/lj [Legislation & Jurisprudence]
Medicaid/sn [Statistics & Numerical Data]
Medically Uninsured/sn [Statistics & Numerical Data]
Middle Aged
Minority Groups/sn [Statistics & Numerical Data]
Obesity, Morbid/ec [Economics]
Patient Protection and Affordable Care Act/ec [Economics]
Patient Protection and Affordable Care Act/sn [Statistics & Numerical Data]
Retrospective Studies
Socioeconomic Factors
United States
Young Adult
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/Advanced Laparoscopic and Bariatric Surgery
Journal Article
BACKGROUND: Obesity disproportionately affects vulnerable populations. Bariatric surgery is an effective long-term treatment for obesity-related complications; however, bariatric surgical rates are lower among racial minorities and low-income and publicly insured patients. The Affordable Care Act's Medicaid expansion improved access to health insurance, but its impact on bariatric surgical disparities has not been evaluated. We sought to determine the impact of the Affordable Care Act's Medicaid expansion on disparate utilization rates of bariatric surgery. CONCLUSION: The gap in bariatric surgery rates by insurance and income was reduced after the Affordable Care Act's Medicaid expansion, but racial disparities persisted. Future research should track these trends and identify factors to reduce racial disparity in bariatric surgery. Copyright (c) 2019. Published by Elsevier Inc. METHODS: A total of 47,974 nonelderly adult bariatric surgical patients (ages 18-64 years) were identified in 2 Medicaid-expansion states (Kentucky and Maryland) versus 2 nonexpansion control states (Florida and North Carolina) between 2012 and 2015 using the Healthcare Cost and Utilization Project's State Inpatient Database. Poisson interrupted time series were conducted to determine the adjusted incidence rates of bariatric surgery by insurance (Medicaid/uninsured versus privately insured), income (high income versus low income), and race (African American versus white). The difference in the counts of bariatric surgery were then calculated to measure the gap in bariatric surgery rates. RESULTS: The adjusted incidence rate of bariatric surgery among Medicaid or uninsured and low-income patients increased by 15.8% and 5.1% per quarter, respectively, after the Affordable Care Act in expansion states (P < .001). No marginal change was seen in privately insured and high-income patients in expansion states. The adjusted incidence rates increased among African American and white patients, but these rates did not change significantly before and after the Affordable Care Act in expansion states.
English
0039-6060
10.1016/j.surg.2019.05.005 [doi] S0039-6060(19)30244-2 [pii]
*Bariatric Surgery/sn [Statistics & Numerical Data]
*Healthcare Disparities/sn [Statistics & Numerical Data]
*Obesity, Morbid/su [Surgery]
*Patient Acceptance of Health Care/sn [Statistics & Numerical Data]
*Patient Protection and Affordable Care Act/lj [Legislation & Jurisprudence]
*Vulnerable Populations/sn [Statistics & Numerical Data]
Adolescent
Adult
African Americans/sn [Statistics & Numerical Data]
Bariatric Surgery/ec [Economics]
Bariatric Surgery/lj [Legislation & Jurisprudence]
European Continental Ancestry Group/sn [Statistics & Numerical Data]
Female
Humans
Male
Medicaid/ec [Economics]
Medicaid/lj [Legislation & Jurisprudence]
Medicaid/sn [Statistics & Numerical Data]
Medically Uninsured/sn [Statistics & Numerical Data]
Middle Aged
Minority Groups/sn [Statistics & Numerical Data]
Obesity, Morbid/ec [Economics]
Patient Protection and Affordable Care Act/ec [Economics]
Patient Protection and Affordable Care Act/sn [Statistics & Numerical Data]
Retrospective Studies
Socioeconomic Factors
United States
Young Adult
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/Advanced Laparoscopic and Bariatric Surgery
Journal Article