Trends in the Utilization of Metabolic and Bariatric Surgery (MBS) Procedures by Race and Ethnicity in Florida (2006-2017)

Abstract Metabolic and bariatric surgery (MBS) is an increasingly common treatment option for individuals with severe obesity, but utilization disparities remain with race and ethnic minority groups completing the procedure less frequently than non-Hispanic Whites. We examined the trends in MBS procedure types and prevalence of utilization by race and ethnicity among Florida inpatients. Discharge records with any MBS using the International Classification of Diseases 9th or 10th edition Procedure Coding System (ICD-PCS), were extracted from the Florida Agency for Health Care Administration (AHCA) inpatients’ data (2006 to 2017). Those who completed either Laparoscopic Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG), Laparoscopic Adjustable Gastric Banding (LAGB), LAGB Revision and Repair (LAGBREV), or LAGB Removal (LAGBREM) were included in the analysis. Cochran-Mantel-Haenszel tests evaluated the trend over time for MBS procedure by race and ethnicity. The sample (n = 90,845) was predominantly non-Hispanic White (NHW, 61.7%), female (75.5%), had a commercial insurance carrier (50.0%), and severe obesity (92.3%). Significant trends (p \u3c 0.05) in three MBS procedures were observed: decreasing trends for LAGB (36.2% in 2008 to 0.3% in 2017) and for RYGB (52.2% in 2009 to 20.3% in 2017) and an increasing trend for SG (18.7% in 2010 to 75.3% in 2017). Regardless of procedure type, NHW had the highest proportion of MBS in all years. More non-Hispanic Blacks received LAGB compared to Hispanics in 2006 through 2016. From 2009 to 2017, more Hispanics received RYGB compared to the NHB inpatients. RYGB was the prevalent procedure from 2006 to 2012 but was later (2013-2017) replaced by SG in Florida hospitals. The diversity in MBS procedures among race-ethnic groups in Florida may indicate social-cultural drivers and should be further investigated

Blood Lead Levels in Children and Environmental Lead Contamination in Miami Inner City, Florida

Studies have shown that the environmental conditions of the home are important predictors of health, especially in low-income communities. Understanding the relationship between the environment and health is crucial in the management of certain diseases. One health outcome related to the home environment among urban, minority, and low-income children is childhood lead poisoning. The most common sources of lead exposure for children are lead paint in older, dilapidated housing and contaminated dust and soil produced by accumulated residue of leaded gasoline. Blood lead levels (BLL) as low as 10 ?g/dL in children are associated with impaired cognitive function, behavior difficulties, and reduced intelligence. Recently, it is suggested that the standard for intervention be lowered to BLL of 5 ?g/dl. The objectives of our report were to assess the prevalence of lead poisoning among children under six years of age and to quantify and test the correlations between BLL in children and lead exposure levels in their environment. This cross-sectional analysis was restricted to 75 children under six years of age who lived in 6 zip code areas of inner city Miami. These locations exhibited unacceptably high levels of lead dust and soil in areas where children live and play. Using the 5 ?g/dL as the cutoff point, the prevalence of lead poisoning among the study sample was 13.33%. The study revealed that lead levels in floor dust and window sill samples were positively and significantly correlated with BLL among children (p \u3c 0.05). However, the correlations between BLL and the soil, air, and water samples were not significant. Based on this pilot study, a more comprehensive environmental study in surrounding inner city areas is warranted. Parental education on proper housecleaning techniques may also benefit those living in the high lead-exposed communities of inner city Miami

Suicide Attempts among Latinas who Experienced Early Sex Were Largely Mediated by Substance Abuse

The purpose of this study was to describe the role of substance abuse as a mediating factor between early sexual experiences and suicide attempts among adult Latinas. In our study participants (n=158), nearly 15% had attempted suicide and 39% experienced their first sexual encounter at an age of 15 or younger (referred to hereafter as “early sex”). Latinas who experienced early sex were more likely to attempt suicide [OR=2.4, p\u3c0.05], and this relationship was largely mediated by substance abuse. An early sexual debut may indicate an environmental adversity on the child that calls for long term intervention for prevention of substance abuse as well as promotion of psychological well-being later in life

Sociodemographic Correlates of Bariatric Surgery by Procedure Type among a Statewide Ethnically Diverse Patient Population

Florida Agency for Health Care Administration (AHCA) 2013 inpatient data was used to conduct a retrospective review using International Classification of Diseases 9th edition (ICD-9) procedure codes to examine the sociodemographic correlates of three bariatric procedures [Laparoscopic Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Adjustable Gastric Banding (LAGB), and Sleeve Gastrectomy (SG)]. Race-ethnic groups included non-Hispanic white (NHW), non- Hispanic black (NHB), Hispanic, and other. The sample (n=6,424, mean age 46 years) was predominantly NHW (57.4%), female (74.9%), commercial-insurance carriers (51.2%), and severely obese (98.8%). SG was the most common procedure (57.9%) followed by RYGB (39.3%), and LAGB (2.8%). Regardless of bariatric procedure type, over 40% were covered by commercial insurance. The relationship between insurance status and bariatric procedure type was statistically significant (p\u3c0.01). However, race-ethnicity and bariatric procedure relationship was not significant after adjusting for age, sex, and insurance status. Despite the current high obesity frequencies across all demographics in the state of Florida, NHW women (compared to their sex-ethnic-specific counterparts) in our sample received the highest proportion of bariatric surgeries. Further research should examine why this finding continues despite obesity and its health-related consequences affecting all sex- ethnic groups

Original Reports on Focus Area: Health Disparities--Race/Ethnic Disparity in Hypertension-Related Hospitalization in Florida

The objective of this paper was to study racial and ethnic disparities among black, white and Hispanic patients hospitalized for hypertension in Florida. Results of the study included findings that the prevalence of hypertension was hightest among blacks, whiel more whites were hospitalized than the other study groups. Differences were also found in discharge status, insurance type and adjusted length of stay according to ethnic groups. Recommendations for further study are also noted

Competencies acquired in epidemiology doctoral programs

The purpose of the study was to compile and describe the range of competencies imparted by doctoral programs in epidemiology using publicly available information. Through the Council on Education for Public Health database, institutions conferring doctoral (PhD, ScD, DrPH) degrees in epidemiology were identified. The competencies listed on the corresponding institutions' websites were extracted and summarized. Forty-eight PhD and thirteen DrPH institutions indicate that their graduates will gain 11 common competencies. The most frequently noted competency for both PhD (93.7%) and DrPH (100%) degrees is related to the communication domain, reflecting the need for graduates to be able to effectively communicate epidemiologic information to others (epidemiology peers, other scientists, policy makers, students). Although variations in the listed competencies exist among doctoral programs in epidemiology, there are common competencies across programs. Further examination of these programs is required to capture information beyond that conveyed on the websites. This preliminary report, along with those findings presented in previous reports on doctoral education, may stimulate further discussion with a group of faculty teaching at the doctoral level, employers of doctoral graduates, and/or the Association of Schools and Programs of Public Health representatives

Differences in HIV-Related Hospitalization Among White, Black, and Hispanic Men and Women of Florida

Patients hospitalized for Human immunodeficiency virus (HIV) disease among the multi-ethnic population of Florida have been incompletely characterized to date. The objectives of the present study were to determine the race/ethnic (whites, blacks, Hispanics) differences in characteristics of patients by gender and the correlates of HIV-related mortality among them. A retrospective analysis of 9,113 discharge records (January to December 2001) with primary diagnosis of HIV disease was performed. Characteristics of patients in six sex-race/ethnic groups were compared using the χ 2 tests and multiple regression models. A multiple logistic regression modeling was used to evaluate the odds of HIV-related death associated with these characteristics. Approximately 64%, 23%, and 13% of records were for blacks, whites, and Hispanics, respectively. The adjusted length of stay (LOS) and hospital charges significantly differed only between black men and women. The insurance status, LOS, and age were significant correlates of HIV-related deaths. The potential causes of disparities between sex-ethnic groups of patients should be further explored