Background

Methods to quantitate disparities in access to surgery in vulnerable populations while considering selection effects and confounding factors are needed. The purpose of our report is to identify factors that contribute to disparities in access to bariatric surgery at the county-level in North Carolina (NC).

Methods

We utilized data from the Health Cost and Utilization Project State Inpatient and Outpatient Database from 2016. Using the rate of bariatric surgery in the county with the best health outcome as the reference, we calculated Surgical Equity Index (SEI) in the remaining counties in NC. Predictors of bariatric surgery were analyzed in a multivariable Poisson model following a multivariable hierarchical regression analysis.

Results

A statistically significantly difference in the SEI was observed in 89 counties. Univariable analyses identified the following variables to be significantly associated with the SEI: percent rural (Relative rate change in SEI (RR)= 0.994, 95% CI 0.92-0.997; p<0.0001), median household income (RR=1.0, 95% CI= 1.0-1.0; p=0.0002), prevalence of diabetes (RR=0.947, 95% CI 0.917-0.977; p=0.0006), the primary care physician ratio (RR=0.995, 95% CI 0.991-0.998; p=0.006) and percent uninsured adults (RR=0.955, 95% CI 0.927-0.985; p=0.003). By multivariable hierarchical regression analysis, only the percent rural remained statistically associated with low SEI (RR=0.995 per 1% increase in rurality, 95% CI=0.992, 0.998; p=0.0002).

Conclusions

Residing in a rural county in NC is the most significant predictor of disparities in access to bariatric surgery. Understanding the characteristics of rurality that are barriers to access are needed to mitigate disparities in bariatric surgical access in NC.