Influence of social deprivation on provision of bariatric surgery: 10-year comparative ecological study between two UK specialist centres

Abstract

ObjectiveTo investigate the effect of residential location and socioeconomic deprivation on the provision of bariatric surgery.DesignRetrospective cross-sectional ecological study.SettingPatients resident local to one of two specialist bariatric units, in different regions of the UK, who received obesity surgery between 2003 and 2013.MethodsDemographic data were collected from prospectively collected databases. Index of Multiple Deprivation (IMD 2010) was used as a measure of socioeconomic status. Obesity prevalences were obtained from Public Health England (2006). Patients were split into three IMD tertiles (high, median, low) and also tertiles of time. A generalised linear model was generated for each time period to investigate the effect of socioeconomic deprivation on the relationship between bariatric case count and prevalence of obesity. We used these to estimate surgical intervention provided in each population in each period at differing levels of deprivation.ResultsData were included from 1163 bariatric cases (centre 1–414, centre 2–749). Incidence rate ratios (IRRs) were calculated to measure the associations between predictor and response variables. Associations were highly non-linear and changed over the 10-year study period. In general, the relationship between surgical case volume and obesity prevalence has weakened over time, with high volumes becoming less associated with prevalence of obesity.DiscussionAs bariatric services have matured, the associations between demand and supply factors have changed. Socioeconomic deprivation is not apparently a barrier to service provision more recently, but the positive relationships between obesity and surgical volume we would expect to find are absent. This suggests that interventions are not being taken up in the areas of need. We recommend a more detailed national analysis of the relationship between supply side and demand side factors in the provision of bariatric surgery.

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries

“…The data from this study supports data from previous studies that patients of non-white ethnicity were at a higher risk of symptomatic COVID-19 postoperatively [33]. This may be due to several factors as non-white patients in this study come from countries with diverse healthcare systems and disease burdens [34]. Even within the same country, non-white populations may be at higher risk due to socio-economic and cultural factors.…”

Mortality of the Severely Obese

“…37 A recent report from the Royal College of Surgeons also identified that 3% of Clinical Commissioning Groups have policies that do not follow national guidelines and subsequently restrict access to bariatric surgery. 38 Meanwhile, a recent analysis by Bhanderi et al 39 identified factors that may reduce access to bariatric procedures, including geographic variability and local deprivation. Reduction of such barriers to bariatric surgery would most likely therefore help improve all-cause mortality in the severely obese population in the United Kingdom.…”

Preoperative bariatric surgery programme barriers facing Pacific patients in Auckland, New Zealand as perceived by health sector professionals: a qualitative study

“…Participants considered that the preoperative health behaviour change requirements to qualify for surgery were particularly demanding for Pacific patients who may live in more challenging socioeconomic situations compared with patients of other ethnicities. This is reflected in the wider literature investigating socioeconomic barriers to health in NZ19–22 38 and bariatric surgery utilisation in the UK, the USA, Canada, Australia and Sweden 2–5 39–41. Such patients are exposed to more obeseogenic factors and are less able to offset risk factors given higher financial pressures and lower education levels.…”