They found that as bariatric surgery gained popularity and surgical techniques improved, it became more and more an option for those with private insurance and those residing in higher income areas, a trend they call "worrisome."
In 1998, for example, about one out of four patients (24.7%) lacked private insurance. By 2002 that had fallen to one out of six (17.1%)
In 1998, 32 percent of patients came from households located in zip codes with an average income greater than $45,000 a year (from 1990 census data, the highest available category). By 2002, that had nearly doubled to 60 percent.
"This income bracket has driven the increase," said Santry. In 1998, there were 4,269 patients from this group. By 2002, that had increased ten fold, to 43,055.
"The data don't allow us to determine whether the increased popularity of bariatric surgery among wealthier persons is a result of differences in access to care or patient choice," said co-author Lauderdale.
Surgical treatment for those from less wealthy neighborhoods also increased but at a much slower pace.
The authors found that despite a shift toward higher-risk patients, in-hospital complications remained stable and length of hospital stay decreased from 4.5 days in 1998 to 3.3 days in 2002.
As obesity spreads, surgical treatment increases and procedures improve, "policymakers should examine the factors associated with the uneven use of bariatric surgery," the authors suggest.
They also note that although 36 percent of obese adults are male, only 20 percent of obesity surgical patients are men.
Public health campaigns, they suggest, may "help shift thinking about obesity from a cosmetic concern of women to a health concern for both sexes."
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Contact: John Easton
John.Easton@uchospitals.edu
773-702-6241
University of Chicago Medical Center
18-Oct-2005