@article{5b4d661131dd4e9cad2925165361f861,
title = "A framework for studying race-based disparities in the use of metabolic and bariatric surgery for the management of pediatric obesity",
author = "Perez, {Numa P.} and Stanford, {Fatima Cody} and Kibileri Williams and Johnson, {Veronica R.} and Evan Nadler and Kanika Bowen-Jallow",
note = "Funding Information: The relationship between surgeon bias and their ultimate decision to offer MBS to patients of different race/ethnicity, insurance coverage, and SES, has also not been directly explored, though it is not unreasonable to hypothesize it may impact clinical practice. For example, a study using the MBSAQIP database found Black patients were more likely to receive a prophylactic IVC filter prior to MBS, despite having lower prevalence of venous thromboembolism risk factors.16 Another study found that Black patients were more likely to undergo amputations for lower extremity claudication than White patients, and this disparity was more pronounced among high volume surgeons.17 Studies like these highlight the effect that provider racial bias (whether implicit or explicit) can have on practice patterns, and merit further consideration. Another factor potentially influencing surgeons{\textquoteright} likelihood of offering MBS to patient who are racial/ethnic minorities as well as those with government-sponsored insurance may be a perceived higher rate of postoperative complications among these populations, though studies exploring this relationship have provided mixed results at best.18–22 Moreover, when evaluating outcomes it is important to account not only for race/ethnicity and insurance coverage, but for more fundamental social determinants of health such as employment and availability of healthy foods and safe play spaces, which may themselves be the primary drivers associated with potential differences in outcomes.Modest progress has certainly been made in ameliorating healthcare disparities since the report by the Institute of Medicine titled “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” was published in 2003,23 with a recent study, for example, finding previously identified race-based disparities in the use of panniculectomies were eliminated among adult patient who underwent the procedure after MBS, which supports the importance of access to care as a potential equalizer of healthcare disparities.24 Nevertheless, without a systematic approach for studying the drivers behind documented race-based disparities in the use of MBS among pediatric patients with severe obesity, we are likely to embark on misguided and ineffective interventions that ultimately continue to deny this vulnerable population what may be the most effective treatment for their disease. If there's one thing that has become abundantly clear during the recent times of racial reckoning in the U.S., is that blind acceptance of the status quo is no longer tolerable. We must seek to understand the forces behind the racial inequities that permeate our society and healthcare system, so we can move to swiftly addressing them, and hopefully one day, eliminating them altogether.",
year = "2021",
month = jul,
doi = "10.1016/j.amjsurg.2020.11.043",
language = "English (US)",
volume = "222",
pages = "49--51",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "1",
}
