ArticleObesity surgery2026
Social Vulnerability and Age at Sleeve Gastrectomy among Adolescents: Does ZIP Code Make a Difference? - A COSMIC Retrospective Study.
Article in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionPediatric obesity affects nearly 1 in 5 U.S. youth, with greater burden among low-income and minority populations. Although bariatric surgery is effective treatment for severe obesity, equitable access to multi-disciplinary care remains a concern for many children and adolescents. This study examined whether ZIP code-level poverty and broader social vulnerability are associated with age at surgery, and whether gender or insurance type modifies this relationship.
methodsWe reviewed charts of patients under 21 who underwent sleeve gastrectomy at three pediatric hospitals (2013–2024). Demographic and clinical data were collected. ZIP code poverty rates were assigned using ACS 5-Year Estimates, and social vulnerability was assessed using the Social Vulnerability Index (SVI). Multiple linear regression assessed associations with age at surgery, adjusting for year of surgery and center and including interactions by gender and insurance type.
resultsAmong 318 patients (38% male), mean age at surgery was 16.78 (males) and 17.16 (females). The poverty model explained little variation in age at surgery and did not show significant main effects of poverty or interactions with gender or insurance type. Girls were on average slightly older at the time of surgery than boys, but this difference did not appear to be meaningfully modified by ZIP-code poverty in adjusted models. The SVI-based model was statistically significant (p < 0.001), but the main effect of SVI and its interaction with gender were small and not robust; an interaction with insurance type was observed only in exploratory analyses. Across all models, females were on average about 0.7–0.8 years older at surgery than males after adjustment for poverty or SVI, year, and center.
conclusionGirls were on average slightly older at the time of surgery than boys, but we did not find robust evidence that higher poverty or social vulnerability specifically delayed surgery among females. Further research is needed to address disparities and improve equitable access to metabolic and bariatric surgery for youth.
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