In Reply We appreciate the relevant and insightful commentary provided by Shah and Shah in their letter regarding our article.1 The authors are correct in their assessment of the association of social determinants with health status, including weight, stress, and socioeconomic status. Our study patient population is generally representative of the bariatric surgery population by age, sex, and weight parameters. This study population is also representative of the diverse ethnic representation present in the San Francisco Bay Area, as we have cited.2 While we do have patient zip code data that could be used for income status, this is a broad assessment not appropriate for individual-level analysis. Education is a key parameter that should be measured in the future, and we appreciate the authors’ suggestion.
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Morton J, Garg T, Leva N. Concerning Greater Social Contexts in Bariatric Surgery Availability and Telomere Length Outcomes—Reply. JAMA Surg. Published online June 12, 2019. doi:10.1001/jamasurg.2019.1727
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