Supplementary Online Content
eFigure 1. Flow of Participants in the Longitudinal Assessment of Bariatric Surgery-2 Study
eAppendix 1. Sensitivity Analysis of Missing at Random Assumption
eAppendix 1Table 1. Primary and Secondary Outcomes by Time Point by whether that Outcome was Observed or Missing at Each Follow-up Assessmenta
eAppendix 1 Table 2. Modeled Prevalence of AUD Symptoms and Illicit Drug Use among Adults Who Underwent RYGB or LAGB,Utilizing Imputed Data That Did Not Assume Missing at Random
eAppendix 1 Table 3. Cumulative Incidence of AUD Symptoms and Illicit Drug Use, at the End of Annual Assessments, Among Adults without the Respective Outcome in the Year Prior to Surgery, Utilizing Imputed Data that Did Not Assume Missing at Random
eTable 1. Baseline Participant Characteristics of Those Included (N=2003) vs. Excluded (N=154) in the Analysis Sample
eTable2A. Observed Prevalence of Substance Use and Indicators of Related Problems among Adults Who Underwent RYGB or LAGB
eTable2B. Modeled Prevalencea of Substance Use and Indicators of Related Problems among Adults Who Underwent RYGB or LAGB
eTable3. Cumulative Incidence of SUD Outcomes, at the End of Annual Assessments, among Adults without the Respective Outcome in the Year prior to Surgery
This supplementary material has been provided by the authors to give readers additional information about their work.
1
eAppendix 1. Sensitivity Analysis of Missing at Random Assumption
A sensitivity analysis was performed to examine the robustness of results with respect to the missing at random assumption. Among those missing vs not missing alcohol use disorder (AUD) status at follow-up, the prevalence of AUD at other follow-up time points appeared greater after controlling for factors (i.e., site, age, and smoking status) that were independently related to the completeness of follow-up data (eAppendix, Table 1). Therefore, a sensitivity analysis was performed using imputed data. When missing AUD status was followed by known AUD status, the missing status was imputed from a logistic regression model containing baseline variables related to the completeness of follow-up data (i.e., site, age, and smoking status) and to the prevalence of AUD (surgical procedure, sex, baseline ISEL-belonging score, baseline SF-36 MCS, and AUD status from all previous follow-up assessments)1. To impute missing AUD status that was not followed by known AUD status, a pattern mixture model that did not assume missing at random was used2. Finally, multiple imputation was used to combine the results from 30 imputed datasets. This process was repeated for illicit drug use, but not for SUD treatment because it was so rare. The modeled prevalence and incidence estimates and 95% CI from the sensitivity analysis are reported in eAppendix 1, Tables 2 and 3 [Supplement].
The modeled prevalence of AUD and illicit drug use and patterns of change over time utilizing imputed data, not assuming data missing at random (eAppendix 1, Table 2 [Supplement]), were similar to the primary analyses (eTable3), indicating the primary modeled results can be used to draw conclusions about the entire analysis sample. The modeled cumulative incidence rates of AUD and illicit drug use utilizing imputed data (eAppendix 1, Table 3 [Supplement]) were slightly higher than the primary analysis (eTable4), particularly at earlier time points, reflecting that intermittent missing time points were counted as “no event” in the primary analysis.
1 Li KH. Imputation using Markov chains. J Stat Comput Simul. 1988;30(1):57-79.
2 Pattern-mixture models. In: Molenberghs G, Kenward MG. Missing Data in Clinical Studies. Hoboken, NJ: John Wiley & Sons Inc; 2007: Chap 16.
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eAppendix1 Table 1. Modeled Prevalence of Primary SUD Outcomesby Time Pointby whetherthat Outcome was Missing or Observed at each Follow-up Assessment
Whether OutcomeKnown, by year of follow-upbYear 1 / Year 2 / Year 3 / Year 4 / Year 5 / Year 7
AUD, % / Missing
(N=321) / Observed
(N=1667) / Missing
(N=500) / Observed
(N=1488) / Missing
(N=573) / Observed
(N=1415) / Missing
(N=600) / Observed
(N=1388) / Missing
(N=588) / Observed
(N=1400) / Missing
(N=985) / Observed
(N=1003)
Year 1 / - / - / 10.3
(7.4-14.4) / 7.3
(5.4-10.0) / 8.4
(6.0-11.9) / 6.7
(5.0-9.2) / 10.3
(7.4-14.4) / 7.1
(5.2-9.8) / 11.5
(8.3-16.1) / 6.7
(4.9-9.2) / 8.2
(5.9-11.3) / 8.0
(5.8-11.0)
Year 2 / 14.5
(10.2-20.7) / 9.8
(7.3-13.3) / - / - / 10.9
(7.8-15.2) / 8.7
(6.4-11.7) / 13.7
(9.9-19.0) / 9.5
(7.0-12.8) / 15.5
(11.3-21.3) / 9.0
(6.6-12.3) / 10.9
(8.0-14.9) / 10.6
(7.7-14.5)
Year 3 / 16.9
(11.9-24.1) / 11.4
(8.5-15.4) / 16.1
(11.7-22.2) / 11.5
(8.5-15.4) / - / - / 16.0
(11.5-22.2) / 11.0
(8.2-14.9) / 18.2
(13.2-25.0) / 10.6
(7.8-14.3) / 12.7
(9.3-17.4) / 12.3
(9.1-16.7)
Year 4 / 18.0
(12.7-25.6) / 12.2
(9.1-16.4) / 17.3
(12.6-23.9) / 12.3
(9.2-16.6) / 13.4
(9.6-18.7) / 10.7
(7.9-14.3) / - / - / 19.5
(14.2-27.0) / 11.3
(8.4-15.3) / 13.5
(9.9-18.5) / 13.1
(9.7-17.8)
Year 5 / 19.3
(13.7-27.3) / 13.1
(9.8-17.6) / 18.5
(13.5-25.4) / 13.2
(9.8-17.7) / 14.0
(10.1-19.4) / 11.1
(8.3-15.0) / 18.4
(13.3-25.5) / 12.7
(9.5-17.1) / - / - / 14.4
(10.5-19.6 / 13.9
(10.3-18.9)
Year 7 / 18.6
(13.0-26.6) / 12.6
(9.4-17.0) / 18.1
(13.1-25.0) / 12.9
(9.5-17.4) / 14.2
(10.2-20.0) / 11.4
(8.4-15.4) / 17.5
(12.6-24.5) / 12.2
(9.0-16.5) / 20.3
(14.6-28.2) / 11.8
(8.7-16.0) / - / -
Illicit drug use % / Missing
(N=324) / Observed
(N=1661) / Missing
(N=509) / Observed
(N=1476) / Missing
(N=571) / Observed
(N=1414) / Missing
(N=601) / Observed
(N=1384) / Missing
(N=587) / Observed
(N=1398) / Missing
(N=980) / Observed
(N=1005)
Year 1 / - / - / 4.5
(2.7-7.5) / 3.5
(2.2-5.6) / 5.8
(3.6-9.6) / 3.1
(1.9-4.9) / 5.5
(3.3-9.0) / 3.2
(2.0-5.2) / 6.4
(3.9-10.7) / 2.9
(1.7-4.7) / 4.4
(2.7-7.3) / 3.3
(2.0-5.6)
Year 2 / 5.5
(3.1-9.9) / 3.5
(2.2-5.7) / - / - / 5.6
(3.4-9.4) / 2.9
(1.8-4.8) / 5.4
(3.3-9.1) / 3.2
(2.0-5.2) / 6.4
(3.8-10.7) / 2.8
(1.7-4.8) / 4.3
(2.6-7.2) / 3.2
(1.9-5.6)
Year 3 / 6.1
(3.5-10.9) / 4.0
(2.5-6.4) / 5.4
(3.2-9.2) / 4.2
(2.7-6.7) / - / - / 6.2
(3.7-10.3) / 3.6
(2.2-5.8) / 7.5
(4.5-12.5) / 3.3
(2.0-5.5) / 5.0
(3.0-8.3) / 3.7
(2.2-6.3)
Year 4 / 5.9
(3.3-10.6) / 3.8
(2.4-6.2) / 5.1
(3.0-8.6) / 4.0
(2.5-6.3) / 6.5
(3.9-10.8) / 3.4
(2.1-5.5) / - / - / 7.3
(4.3-12.4) / 3.3
(2.0-5.4) / 4.8
(2.9-8.1) / 3.6
(2.1-6.1)
Year 5 / 8.2
(4.7-14.2) / 5.3
(3.4-8.4) / 7.1
(4.3-11.9) / 5.5
(3.6-8.7) / 9.1
(5.7-14.9) / 4.8
(3.0-7.6) / 8.4
(5.1-14.0) / 4.9
(3.1-7.9) / - / - / 6.7
(4.0-11.1) / 5.0
(3.0-8.3)
Year 7 / 7.7
(4.4-13.7) / 5.0
(3.1-8.1) / 6.7
(4.0-11.4) / 5.2
(3.3-8.4) / 8.6
(5.2-14.4) / 4.5
(2.8-7.2) / 7.9
(4.7-13.3) / 4.6
(2.8-7.5) / 9.1
(5.3-15.6) / 4.0
(2.4-6.8) / - / -
eAppendix 1 Table 1 continued on the next page.
eAppendix 1 Table 1.continued.
Whether OutcomeKnown, by year of follow-upbYear 1 / Year 2 / Year 3 / Year 4 / Year 5 / Year 7
SUD treatment, % / Missing
(N=328) / Observed
(N=1597) / Missing
(N=526) / Observed
(N=1399) / Missing
(N=592) / Observed
(N=1333) / Missing
(N=617) / Observed
(N=1308) / Missing
(N=605) / Observed
(N=1320) / Missing
(N=986) / Observed
(N=939)
Year 1 / - / - / 1.1
(0.5-2.8) / 0.8
(0.3-1.9) / 1.5
(0.6-3.8) / 0.6
(0.2-1.6) / 1.3
(0.5-3.3) / 0.7
(0.3-1.8) / 1.3
(0.5-3.4) / 0.7
(0.3-1.8) / 1.1
(0.4-2.9) / 0.7
(0.3-1.7)
Year 2 / 1.2
(0.4-3.5) / 0.8
(0.3-2.0) / - / - / 1.5
(0.6-3.9) / 0.6
(0.2-1.5) / 1.2
(0.5-3.2) / 0.6
(0.2-1.8) / 1.2
(0.4-3.4) / 0.7
(0.2-1.8) / 1.0
(0.4-2.8) / 0.6
(0.2-1.7)
Year 3 / 2.1
(0.8-5.6) / 1.4
(0.6-3.2) / 1.9
(0.8-4.6) / 1.3
(0.6-3.1) / - / - / 2.3
(0.9-5.8) / 1.2
(0.5-2.9) / 2.2
(0.9-5.8) / 1.2
(0.5-3.0) / 2.0
(0.8-5) / 1.2
(0.5-3.0)
Year 4 / 2.1
(0.8-5.7) / 1.4
(0.6-3.3) / 2.0
(0.9-4.8) / 1.4
(0.6-3.2) / 2.7
(1.1-6.9) / 1.1
(0.5-2.5) / - / - / 2.1
(0.8-5.7) / 1.1
(0.5-2.9) / 1.8
(0.7-4.7) / 1.1
(0.4-2.8)
Year 5 / 2.2
(0.8-5.9) / 1.5
(0.7-3.5) / 2.1
(0.9-5.0) / 1.4
(0.6-3.4) / 2.9
(1.2-7.4) / 1.1
(0.5-2.7) / 2.5
(1.0-6.7) / 1.3
(0.6-3.2) / - / - / 2.1
(0.8-5.2) / 1.2
(0.5-3.2)
Year 7 / 1.9
(0.7-5.5) / 1.3
(0.5-3.2) / 1.8
(0.7-4.8) / 1.2
(0.5-3.0) / 2.5
(1.0-6.3) / 1.0
(0.4-2.5) / 2.2
(0.8-6.1) / 1.1
(0.5-2.9) / 2.2
(0.8-6.3) / 1.2
(0.5-3.1) / - / -
Abbreviations:AUD, Alcohol Use Disorder; SUD, Substance Use Disorder.
aPrevalencerates based on mixed models, adjusted for factors independently related to missing follow-up data (i.e., site, age, and baseline smoking status)
eAppendix 1 Table 2. Modeled Prevalence of AUD Symptoms and Illicit Drug Use among Adults Who Underwent RYGB or LAGB, from a Sensitivity Analysis that Does Not Assume Missing at Random
% (95%CI)N / Baseline / Year 1 / Year 2 / Year 3 / Year 4 / Year 5 / Year 7 / P for trenda
RYGB
AUD symptoms / 1481 / 6.6(5.5-8.0) / 8.4(6.9-10.1) / 12.1(10.2-14.4) / 14.3(12.4-16.6) / 14.8(12.9-17) / 15.4(13.3-17.9) / 16.2(13.9-19) / <.01b
Illicit drug use / 1481 / 4.4(3.4-5.5) / 3.9(3.0-5.2) / 4.2(3.2-5.5) / 5.4(4.2-6.9) / 4.5(3.4-5.9) / 6.3(5.0-7.9) / 7.0(5.4-9.2) / <.01b
LAGB
AUD symptoms / 522 / 6.9(5.1-9.5) / 6.2(4.3-8.9) / 7.3(5.2-10.1) / 7.8(5.5-11.1) / 9.0(6.4-12.7) / 8.7(6.1-12.3) / 6.9(4.3-11.0) / 0.10
Illicit drug use / 522 / 3.9(2.5-5.9) / 3.2(1.9-5.3) / 3.5(2.1-5.9) / 2.5(1.4-4.5) / 4.0(2.2-7.0) / 4.3(2.7-6.9) / 3.5(1.7-7.2) / 0.53
Abbreviations: AUD, Alcohol Use Disorder; AUDIT, Alcohol Use Disorder Identification Test; LAGB, laparoscopic adjustable gastric banding;RYGB, Roux-en-Y gastric bypass; SUD, Substance Use Disorder.
aLinear trend unless otherwise specified. bQuadratic trend.
eAppendix 1 Table 3. Cumulative Incidence of AUD Symptoms and Illicit Drug Use, at the End of Annual Assessments, Among Adultswithout the Respective Outcome in the Year Prior to Surgery, Utilizing Imputed Data thatDid Not Assume Missing at Random
Post-surgery outcomes by assessment year / Cumulative % (95% CI)RYGB / LAGB
AUD symptoms, y / n=1383 / n=486
1 / 8.4(6.4-10.3) / 3.6(1.3-5.9)
2 / 15.3(12.7-17.8) / 7.6(4.3-10.9)
3 / 21.1(18.2-24.0) / 11.9(7.9-16.0)
4 / 25.6(22.5-28.7) / 15.4(10.9-19.9)
5 / 30.0(26.7-33.3) / 18.2(13.3-23.0)
Illicit drug use, y / n=1417 / n=502
1 / 2.8(1.6-3.9) / 2.4(0.5-4.3)
2 / 4.7(3.2-6.3) / 4.0(1.6-6.4)
3 / 7.4(5.5-9.2) / 4.4(1.8-6.9)
4 / 9.5(7.4-11.6) / 5.2(2.5-8.0)
5 / 12.0(9.6-14.3) / 7.6(4.3-10.9)
Abbreviations: AUD, Alcohol Use Disorder; LAGB, laparoscopic adjustable gastric banding;RYGB, Roux-en-Y gastric bypass; SUD, Substance Use Disorder.
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eTable1. Baseline Participant Characteristics of those Included vs.Excluded in the Analysis Sample.
Included(n = 2003)a / Excluded
(n = 154)a / P
Sociodemographics
Sex, No.(%)
Male / 1586 / (79.2) / 119 / (77.3) / 0.58
Female / 417 / (20.8) / 35 / (22.7)
Age, median (IQR), y / 47(37,55) / 39(34,45) / <.0001
Race, No.(%) / (N=1983) / (N=151) / 0.94
White / 1725 / (87.0) / 134 / (87.6)
Black / 196 / (9.9) / 15 / (9.8)
Otherb / 62 / (3.1) / 4 / (2.6)
Hispanic ethnicity, No./Total No. (%) / 92/2001 / (4.6) / 13/154 / (8.4) / 0.03
Relationship status, No. (%) / (N=1993) / (N=151) / 0.43
Married or living as married / 1278 / (64.1) / 92 / (60.9)
Divorced, separated or widowed / 400 / (20.1) / 29 / (19.2)
Never married / 315 / (15.8) / 30 / (19.9)
Education, No. (%) / (N=1994) / (N=151) / 0.36
≤ High school / 464 / (23.3) / 35 / (23.2)
Some college / 803 / (40.3) / 70 / (46.4)
≥ College degree / 727 / (36.5) / 46 / (30.5)
Employment status, No. (%) / (N=1987) / (N=150) / 0.17
Employed / 1355 / (68.2) / 113 / (75.3)
Unemployed / 75 / (3.8) / 3 / (2.0)
Disabled / 298 / (15.0) / 22 / (14.7)
Other / 259 / (13.0) / 12 / (8.0)
Household income, $, No. (%) / (N=1940) / (N=149) / 0.64
< 25 000 / 354 / (18.2) / 22 / (14.8)
25 000-49 000 / 505 / (26.0) / 41 / (27.5)
50 000-74 999 / 456 / (23.5) / 47 / (31.5)
75 000-99 999 / 312 / (16.1) / 22 / (14.8)
≥ 100 000 / 313 / (16.1) / 17 / (11.4)
Body mass index, median (IQR)c / 45.6(41.7,51.1) / 46.5(41.6,52.1) / 0.33
Interpersonal support, quality of life and mental health
ISEL-12 Belonging score / (N=1994) / (N=151)
Median (IQR) / 14(12,16) / 14(12,16) / 0.58
SF-36 Mental component score / (N=1966) / (N=159)
Median (IQR), / 51.7(43.0,57.2) / 50.9(43.0,56.6) / 0.29
Binge eating, No./Total No. (%) / 313/1968 / (15.9) / 15/147 / (10.2) / 0.07
Loss of control eating, No./Total No. (%) / 700/1979 / (35.4) / 53/151 / (35.1) / 0.95
Antidepressant medication, No./Total No. (%) / 746/1941 / (38.4) / 56/148 / (37.8) / 0.23
Benzodiazepine medication, No./Total No. (%) / 177/1952 / (9.1) / 18/150 / (12.0) / 0.89
Psychiatric counseling, No./Total No. (%) / 455/1984 / (22.9) / 39/153 / (25.5) / 0.47
History of psychiatric hospitalization, No./Total No. (%) / 198/1989 / (10.0) / 14/152 / (9.2) / 0.77
Substance Use, past year
Smoking, No./Total No. (%) / 238/2000 / (11.9) / 35/154 / (22.7) / <.0001
Alcohol consumption, No. (%) / (N=1995) / (N=152) / 0.04
None / 821 / (41.2) / 63 / (41.5)
Any / 1043 / (52.2) / 87 / (57.2)
Regular (≥ 2 times/wk) / 131 / (6.6) / 2 / (1.3)
AUD symptoms, No./Total No. (%) / 133/1988 / (6.7) / 6/152 / (3.9) / 0.18
Illicit drug use, No./Total No. (%) / 84/1985 / (4.2) / 9/152 / (5.9) / 0.32
SUD treatment, No./Total No. (%) / 8/1925 / (0.4) / 2/151 / (1.3) / 0.12
Abbreviations:AUD, Alcohol Use Disorder; lQR, interquartile range;LAGB, laparoscopic adjustable gastric banding;ISEL-12, 12-item Interpersonal Support Evaluation List;RYGB, Roux-en-Y gastric bypass; SF-36,Short-Form 36-item Health Survey; SUD, Substance Use Disorder.
aDenominators shift between variables because of missing data.bRacial categories were combined due to small number.cCalculated as weight in kilograms divided by height in meters squared. dAlower score (range 0to12) indicates less support availability.eAlower score (range 0 to 100), indicates worse function.fA higher score (range 0 to 63), indicates greater severity.
.
1
eTable2A. Observed Prevalence of Substance Use and Indicators of Related Problems among Adults Who Underwent RYGB or LAGB.
No./Total No. (%)Baseline / 1 year / 2 years / 3 years / 4 years / 5 years / 7 years
RYGB
Any alcohol consumption / 839/1475 (56.9) / 666/1233 (54.0) / 622/1091 (57.0) / 641/1046 (61.3) / 604/1031 (58.6) / 618/1043 (59.3) / 467/758 (61.6)
Regular alcohol consumption / 90/1475 (6.1) / 113/1233 (9.2) / 131/1091 (12.0) / 158/1046 (15.1) / 155/1031 (15.0) / 169/1043 (16.2) / 141/758 (18.6)
AUD symptomsa / 97/1469 (6.6) / 102/1226 (8.3) / 121/1087 (11.1) / 139/1040 (13.4) / 136/1027 (13.2) / 144/1039 (13.9) / 121/753 (16.1)
AUDIT ≥8 / 41/1473 (2.8) / 47/1228 (3.8) / 76/1088 (7.0) / 80/1044 (7.7) / 73/1028 (7.1) / 93/1041 (8.9) / 77/755 (10.2)
Alcohol-related harm symptoms / 74/1473 (5.0) / 87/1228 (7.1) / 110/1088 (10.1) / 123/1044 (11.8) / 119/1028 (11.6) / 125/1041 (12.0) / 104/755 (13.8)
Dependence symptoms / 48/1468 (3.3) / 55/1227 (4.5) / 75/1087 (6.9) / 87/1039 (8.4) / 90/1026 (8.8) / 99/1038 (9.5) / 81/752 (10.8)
Illicit drug useb / 64/1468 (4.4) / 45/1224 (3.7) / 40/1077 (3.7) / 45/1040 (4.3) / 38/1022 (3.7) / 54/1037 (5.2) / 43/756 (5.7)
Marijuana / 59/1468 (4.0) / 42/1224 (3.4) / 36/1077 (3.3) / 41/1040 (3.9) / 34/1022 (3.3) / 43/1037 (4.2) / 40/756 (5.3)
Other drug use / 11/1468 (0.8) / 9/1224 (0.7) / 9/1077 (0.8) / 9/1040 (0.9) / 10/1022 (1.0) / 11/1037 (1.1) / 6/756 (0.8)
SUD treatment / 7/1424 (0.5) / 12/1179 (1.0) / 9/1020 (0.9) / 15/979 (1.5) / 15/966 (1.6) / 18/978 (1.8) / 12/704 (1.7)
LAGB
Any alcohol consumption / 335/520 (64.4) / 270/442 (61.1) / 258/405 (63.7) / 240/377 (63.7) / 236/362 (65.2) / 226/362 (62.4) / 170/251 (67.7)
Regular alcohol consumption / 41/520 (7.9) / 38/442 (8.6) / 53/405 (13.1) / 50/377 (13.3) / 53/362 (14.6) / 55/362 (15.2) / 38/251 (15.1)
AUD symptomsa / 36/519 (6.9) / 27/441 (6.1) / 28/401 (7.0) / 29/375 (7.7) / 32/361 (8.9) / 31/361 (8.6) / 17/250 (6.8)
AUDIT ≥8 / 13/519 (2.5) / 8/441 (1.8) / 13/402 (3.2) / 14/376 (3.7) / 13/362 (3.6) / 12/361 (3.3) / 6/250 (2.4)
Alcohol-related harm symptoms / 27/519 (5.2) / 23/441 (5.2) / 22/401 (5.5) / 23/376 (6.1) / 27/362 (7.5) / 26/361 (7.2) / 15/250 (6.0)
Dependence symptoms / 16/519 (3.1) / 9/441 (2.0) / 16/402 (4.0) / 14/375 (3.7) / 17/361 (4.7) / 16/362 (4.4) / 8/250 (3.2)
Illicit drug useb / 20/517 (3.9) / 13/437 (3.0) / 14/399 (3.5) / 9/374 (2.4) / 12/362 (3.3) / 14/361 (3.9) / 7/249 (2.8)
Marijuana / 19/517 (3.7) / 12/437 (2.8) / 11/399 (2.8) / 9/374 (2.4) / 12/362 (3.3) / 13/361 (3.6) / 6/249 (2.4)
Other drug use / 3/517 (0.6) / 1/437 (0.2) / 3/399 (0.8) / 1/374 (0.3) / 2/362 (0.6) / 1/361 (0.3) / 1/249 (0.4)
SUD treatment / 1/501 (0.2) / 1/418 (0.2) / 2/379 (0.5) / 1/354 (0.3) / 3/342 (0.6) / 1/342 (0.3) / 1/235 (0.4)
Abbreviations:AUD, Alcohol Use Disorder;AUDIT, Alcohol Use Disorder Identification Test; LAGB, laparoscopic adjustable gastric banding; RYGB, Roux-en-Y gastric bypass; SUD, Substance Use Disorder.
aAlcohol Use Disorders Identification Test score ≥8, or indication of alcohol-related harm or alcohol dependence.bMarijuana, cocaine, amphetamines, hallucinogens, inhalants, and PCP.
eTable2B. Modeled Prevalencea of Substance Use and Indicators of Related Problems among Adults Who Underwent RYGB or LAGB
% (95%CI)N / Baseline / Year 1 / Year 2 / Year 3 / Year 4 / Year 5 / Year 7 / P for trendd
RYGB
Any alcohol consumption / 1472 / 56.8(54.4-59.2) / 54.0(51.4-56.5) / 57.9(55.3-60.5) / 60.7(58.1-63.3) / 59.2(56.6-61.9) / 60.0(57.4-62.7) / 60.0(57.0-62.9) / <.01e
Regular (≥2 times/week) alcohol consumption / 1472 / 6.1(4.9-7.3) / 9.3(7.7-10.8) / 12.4(10.6-14.2) / 15.6(13.6-17.6) / 15.7(13.7-17.8) / 17.3(15.2-19.4) / 18.1(15.6-20.4) / <.0001e
AUD symptomsb / 1466 / 6.6(5.3-7.9) / 8.7(7.2-10.2) / 12.2(10.4-14.0) / 14.2(12.3-16.2) / 15.1(13.1-17.1) / 16.3(14.2-18.4) / 16.4(14.1-18.7) / <.0001e
AUDIT ≥8 / 1470 / 2.8(2-3.6) / 4.0(3.0-5.1) / 7.9(6.4-9.3) / 8.2(6.6-9.7) / 8.1(6.6-9.7) / 10.3(8.6-12.1) / 10.2(8.3-12.2) / <.0001e
Alcohol-related harm / 1470 / 5.0(3.9-6.1) / 7.5(6.0-8.9) / 10.7(9.0-12.4) / 12.2(10.3-14.0) / 13.2(11.3-15.1) / 13.8(11.9-15.8) / 14.0(11.8-16.2) / <.0001e
Dependence symptoms / 1465 / 3.3(2.4-4.2) / 4.9(3.7-6.0) / 8.1(6.6-9.6) / 9.3(7.7-11.0) / 10.5(8.8-12.2) / 11.6(9.7-13.4) / 11.3(9.3-13.3) / <.0001e
Illicit drug usec / 1465 / 4.4(3.3-5.4) / 4.0(3.0-5.0) / 3.9(2.9-5.0) / 5.2(4.0-6.4) / 4.4(3.2-5.6) / 6.3(4.9-7.7) / 6.3(4.7-7.9) / <.0001e
Marijuana use / 1465 / 4.0(3.0-5.0) / 3.8(2.8-4.8) / 3.6(2.6-4.6) / 4.7(3.5-5.8) / 4.0(2.9-5.1) / 5.1(3.9-6.4) / 5.8(4.3-7.4) / <.001e
Other drug use / 1465 / 0.8(0.3-1.2) / 0.7(0.2-1.2) / 1.0(0.4-1.6) / 1.0(0.4-1.7) / 1.0(0.4-1.6) / 1.3(0.6-2.0) / 0.8(0.2-1.5) / .23
SUD treatment / 1422 / 0.5(0.1-0.9) / 1.1(0.5-1.6) / 1.0(0.3-1.6) / 1.6(0.8-2.4) / 1.7(0.8-2.5) / 2.0(1.1-2.9) / 1.7(0.8-2.6) / 0.18
LAGB
Any alcohol consumption / 520 / 64.4(60.4-68.5) / 62.2(58.0-66.3) / 64.1(59.9-68.4) / 64.0(59.6-68.3) / 66.5(62.3-70.8) / 63.7(59.3-68.1) / 67.3(62.7-72.0) / .01e
Regular (≥2 times/week) alcohol consumption / 520 / 7.9(5.6-10.2) / 8.4(6.0-10.9) / 12.8(9.8-15.8) / 13.9(10.7-17.0) / 15.0(11.7-18.2) / 16.2(12.7-19.6) / 16.8(12.9-20.7) / .01e
AUD symptomsb / 519 / 6.9(4.8-9.1) / 6.0(3.9-8.2) / 6.9(4.6-9.3) / 8.1(5.5-10.8) / 8.5(5.7-11.2) / 8.9(6.1-11.7) / 7.0(3.9-10.1) / .09
AUDIT ≥8 / 519 / 2.5(1.2-3.8) / 2.0(0.7-3.2) / 3.1(1.4-4.7) / 4.0(2.2-5.8) / 3.5(1.7-5.3) / 3.3(1.6-5.1) / 3.4(1.4-5.3) / .17
Alcohol-related harm / 519 / 5.2(3.3-7.1) / 5.0(3.0-7.0) / 5.5(3.3-7.7) / 6.5(4.1-8.8) / 7.0(4.4-9.6) / 7.8(5.2-10.4) / 7.5(4.5-10.5) / .21
Dependence symptoms / 519 / 3.1(1.6-4.6) / 1.9(0.6-3.1) / 4.0(2.1-5.9) / 4.0(2.1-5.9) / 4.7(2.5-6.8) / 4.5(2.5-6.6) / 2.9(0.8-5.0) / .92
Illicit drug usec / 517 / 3.9(2.2-5.5) / 3.0(1.4-4.6) / 3.7(1.9-5.5) / 2.5(1.0-3.9) / 4.5(2.7-6.4) / 4.5(2.7-6.4) / 3.1(1.1-5.1) / .33
Marijuana use / 517 / 3.7(2.1-5.3) / 2.9(1.4-4.5) / 3.0(1.4-4.5) / 2.5(1.1-4.0) / 4.5(2.5-6.4) / 4.3(2.4-6.2) / 2.4(0.6-4.2) / .52
Other drug use / 517 / 0.6(0.0-1.2) / 0.3(0.0-0.7) / 0.6(0.0-1.3) / 0.3(0.0-0.7) / 0.5(0.0-1.1) / 0.3(0.0-0.9) / 0.4(0.0-1.3) / .94
SUD treatment / 501 / 0.2(0.0-0.6) / 0.3(0.0-0.8) / 0.6(0.0-1.4) / 0.3(0.0-0.9) / 0.6(0.0-1.5) / 0.3(0.0-1.0) / 0.5(0.0-1.4) / .40
Abbreviations: AUD, Alcohol Use Disorder; AUDIT, Alcohol Use Disorder Identification Test; LAGB, laparoscopic adjustable gastric banding;RYGB, Roux-en-Y gastric bypass; SUD, Substance Use Disorder.
aControlling for age, baseline smoking status and site. bAUDIT score ≥8, or indication of alcohol-related harm or alcohol dependence. cMarijuana, cocaine, amphetamines, hallucinogens, inhalants and phencyclidine (PCP). dLinear trend, unless otherwise specified. eQuadratic trend.
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eTable3. Cumulative Incidence of SUD Outcomes, at the End of Annual Assessments, amongAdults without the Respective Outcome in the Year prior to Surgery
Post-surgery outcomes by assessment year / Cumulative % (95% CI)RYGB / LAGB
AUD symptomsa, y / n=1372 / n=483
1 / 4.9(3.9-6.2) / 1.9(1.0-3.6)
2 / 9.2(7.7-10.9) / 4.1(2.7-6.4)
3 / 13.1(11.4-15.1) / 6.7(4.7-9.5)
4 / 16.5(14.6-18.7) / 9.0(6.7-12.1)
5 / 20.8(18.5-23.3) / 11.3(8.5-14.9)
AUDIT score ≥8, y / n=1432 / n=506
1 / 2.3(1.6-3.2) / 1.0(0.4-2.4)
2 / 5.5(4.4-6.9) / 2.3(1.3-4.1)
3 / 7.8(6.5-9.4) / 4.1(2.6-6.3)
4 / 9.9(8.4-11.7) / 4.8(3.2-7.2)
5 / 13.9(12.1-16.1) / 6.5(4.5-9.5)
Alcohol-related harm, y / n=1399 / n=492
1 / 4.4(3.4-5.6) / 1.2(0.6-2.7)
2 / 8.3(6.9-9.9) / 3.9(2.5-6.1)
3 / 12.0(10.3-13.9) / 5.9(4.1-8.5)
4 / 14.8(13.0-16.9) / 8.7(6.4-11.7)
5 / 18.9(16.8-21.3) / 11.0(8.2-14.5)
Dependence symptoms, y / n=1420 / n=503
1 / 3.1(2.3-4.1) / 1.0(0.4-2.4)
2 / 6.1(5.0-7.5) / 3.2(1.9-5.2)
3 / 9.0(7.6-10.7) / 4.5(3.0-6.8)
4 / 11.9(10.2-13.8) / 6.0(4.1-8.6)
5 / 15.3(13.4-17.5) / 7.7(5.4-10.8)
Illicit drug useb, y / n=1404 / n=497
1 / 1.5(1.0-2.3) / 1.2(0.6-2.7)
2 / 2.7(1.9-3.7) / 2.1(1.1-3.9)
3 / 4.3(3.3-5.5) / 2.3(1.3-4.2)
4 / 5.6(4.5-7.0) / 2.8(1.6-4.8)
5 / 7.5(6.1-9.1) / 4.9(3.1-7.6)
Marijuana use, y / n=1409 / n=498
1 / 1.5(0.9-2.2) / 1.0(0.4-2.4)
2 / 2.4(1.7-3.3) / 1.5(0.7-3.0)
3 / 3.7(2.8-4.9) / 1.9(1.0-3.7)
4 / 4.9(3.8-6.2) / 2.7(1.5-4.6)
5 / 6.3(5.1-7.9) / 4.3(2.7-6.9)
Other drug use, y / n=1457 / n=514
1 / 0.3(0.1-0.8) / 0.2(0.0-1.4)
2 / 0.8(0.4-1.4) / 0.6(0.2-1.9)
3 / 1.3(0.8-2.0) / 0.6(0.2-1.9)
4 / 1.6(1.0-2.4) / 0.6(0.2-1.9)
5 / 2.3(1.6-3.4) / 1.0(0.4-2.8)
SUD Treatment, y / n=1417 / n=500
1 / 0.7(0.4-1.3) / 0.0(0.0-0.0)
2 / 0.9(0.6-1.6) / 0.2(0.0-1.5)
3 / 1.8(1.2-2.7) / 0.4(0.1-1.7)
4 / 2.4(1.7-3.5) / 0.9(0.4-2.5)
5 / 3.5(2.6-4.8) / 0.9(0.4-2.5)
Abbreviations: AUD, Alcohol Use Disorder; AUDIT, Alcohol Use Disorder Identification Test; LAGB, laparoscopic adjustable gastric banding;RYGB, Roux-en-Y gastric bypass; SUD, Substance Use Disorder.
aAUDIT score ≥8, or indication of alcohol-related harm or alcohol dependence. bMarijuana, cocaine, amphetamines, hallucinogens, inhalants and phencyclidine (PCP).
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