NEIGHBORHOOD SOCIOECONOMIC STATUS, UTILIZATION AND SHORT-TERM POSTOPERATIVE OUTCOMES FOLLOWING BARIATRIC SURGERY IN MARYLAND

Abstract

Introduction: Bariatric surgery is an effective and evidence-based treatment for severe obesity; however, socioeconomic disparities in utilization and outcomes persist. This dissertation comprises three interrelated studies aimed at examining the impact of neighborhood socioeconomic status (nSES), as measured by the Distressed Communities Index (DCI), on bariatric surgery utilization and short-term postoperative outcomes in Maryland. The moderating role of race and ethnicity is also explored across these domains. Methods: A cross-sectional analysis was conducted using the 2018–2020 Maryland State Inpatient Database, linked with ZIP code-level DCI data. Multivariable logistic regression models were used to assess associations between nSES and (1) bariatric surgery utilization, (2) short-term postoperative complications, and (3) healthcare quality measures, including length of hospital stay and 30-day readmissions. Interaction terms and marginal effects were used to evaluate race/ethnicity as a potential effect modifier. Results: Study I demonstrated that bariatric surgery utilization declined significantly with increasing neighborhood distress. Patients from distressed areas had 31% lower odds of undergoing bariatric surgery compared to those from prosperous neighborhoods (OR: 0.69, 95% CI: 0.63–0.76). Race significantly modified this association: Black individuals were more likely than White individuals to undergo surgery across all nSES levels, with the largest differences observed in the most distressed communities. Study II found no statistically significant association between nSES and short-term postoperative complications, including gastrointestinal leaks, venous thromboembolism, and gastrointestinal bleeding. Race and ethnicity did not significantly modify these relationships. Study III revealed no significant associations between nSES and healthcare quality measures, including prolonged hospital stays and readmissions. Similarly, no interaction effects were observed by race or ethnicity for these outcomes. Conclusion: Neighborhood socioeconomic disadvantage was associated with reduced bariatric surgery utilization, particularly among individuals residing in distressed communities. However, nSES was not significantly associated with short-term surgical outcomes or healthcare quality metrics. Racial differences in surgery utilization persisted across all nSES levels, underscoring the importance of intersectional approaches to addressing inequities in access to bariatric surgery.