Socioeconomically Distressed Communities Associated With Long-term Mortality After Bariatric Surgery

Background: Surgical outcomes are affected by socioeconomic status, yet these factors are poorly accounted for in clinical databases. We sought to determine if the Distressed Communities Index (DCI), a composite ranking by zip code that quantifies socioeconomic risk, was associated with long-term survival after bariatric surgery. Methods: All patients undergoing Roux-en-Y gastric bypass (1985-2004) at a single institution were paired with DCI. Scores range from 0 (no distress) to 100 (severe distress) and account for unemployment, education, poverty, median income, housing vacancies, job growth, and business establishment growth. Distressed communities, defined as DCI >= 75, were compared with all other patients. Regression modeling was used to evaluate the effect of DCI on 10-year bariatric outcomes, whereas Cox Proportional Hazards and Kaplan eMeier analysis examined long-term survival. Results: Gastric bypass patients (n = 681) come from more distressed communities compared with the general public (DCI 60.5 +/- 23.8 versus 50 +/- 10; P < 0.0001). A total of 221 (32.3%) patients came from distressed communities (DCI >= 75). These patients had similar preoperative characteristics, including BMI (51.5 versus 51.7 kg/m(2); P = 0.63). Socioeconomic status did not affect 10-year bariatric outcomes, including percent reduction in excess body mass index (57% versus 58%; P = 0.93). However, patients from distressed communities had decreased risk-adjusted long-term survival (hazard ratio, 1.38; P = 0.043). Conclusions: Patients with low socioeconomic status, as determined by the DCI, have equivalent outcomes after bariatric surgery despite worse long-term survival. Future quality improvement efforts should focus on these persistent disparities in health care. (C) 2019 Elsevier Inc. All rights reserved.