Background

Healthcare disparities in accessibility have been established in several domains, including bariatric surgery. The impact of age on these limitations has not been explored previously. This study aims to examine the factors affecting access to adolescent bariatric surgery.

Methods

The SPARCS database was used to identify adolescent (<19 years) and adult patients undergoing bariatric procedures (2007-2022). Analyses included procedure, demographics, and area deprivation index (ADI). ADI scores (1-10) reflected socioeconomic status (low: 1-4, median: 5-7, high: 8-10). Chi-square tests assessed surgery type and demographics, while Poisson log-linear regression models examined linear trends.

Results

3,512 adolescent patients and 210,178 adult patients were identified. Adolescents showed a lower likelihood of Roux-En-Y Gastric Bypass (RYGB) compared to Sleeve Gastrectomy (SG) (58.41% vs. 70.05%, p<0.0001), lower male representation (20.88% vs. 28.22%, p<0.0001), and lower ADI scores (12.93% vs. 31.12%, p<0.0001). Fewer Black adolescents (11.47% vs. 15.54%, p<0.0001) and more Hispanic adolescents (29.7% vs. 21.16%) underwent surgery compared to adults (Figure 1). Over time, the proportion of Hispanic patients increased and white patients decreased, with no insurance status changes. Commercial insurance was significantly less prevalent than Medicaid/Medicare in both populations (RR 0.97 (0.96-0.98), p<0.0001; RR 0.98(0.98-0.99), p <0.0001, respectively).

Conclusions

Black and highly disadvantaged adolescent patients are less likely to receive bariatric surgery, highlighting the even greater disparities affecting these groups. Differences between adult and adolescent populations are also demonstrated longitudinally. Over time, more adolescent patients received SG, more male adolescents received surgery, and fewer high ADI adolescents received surgery, highlighting disparities in access.