Inequalities in bariatric surgery in Australia: findings from 49,364 obese participants in a prospective cohort study

Abstract

OBJECTIVES: To investigate variation, and quantify socioeconomic inequalities, in receipt of primary bariatric surgery in an obese population. DESIGN, SETTING AND PARTICIPANTS: Prospective population-based cohort study of 49,364 individuals aged 45-74 with body mass index (BMI) ≥30kg/m2, with questionnaire (2006-09) linked to hospital and death data to July 2010. Sample drawn from the 45 and Up Study (~10% of NSW population aged ≥45 included, response rate ~18%). MAIN OUTCOME MEASURES: Rates of bariatric surgery and adjusted rate ratios (RR) in relation to health and sociodemographic characteristics. RESULTS: Over 111,757 person-years (py) of follow-up, 312 participants underwent bariatric surgery, a rate of 27.92/10,000 py (95%CI: 24.91-31.19). Rates were highest in women, people living in major cities and those with diabetes, and increased significantly with increasing body-mass-index and number of chronic health conditions. Adjusted RRs were: 5.27 (3.18-8.73) for annual household-income ≥$70,000 versus <$20,000; and 4.01 (2.41-6.67) for those living in areas in the least- versus most-disadvantaged quintile. Private health insurance (PHI) coverage (age-sex adjusted RR: 9.25; 5.70-15.00) partially explained the observed socioeconomic inequalities. CONCLUSIONS: Bariatric surgery has been shown to be cost-effective in treating severe obesity and associated illnesses. While bariatric surgery rates in Australia are higher in those with health problems, large socioeconomic inequalities are apparent. Our findings suggest these procedures are largely available to those who can afford PHI and associated out-of-pocket costs, with poor access in populations who are most in need. Continuing inequalities in access are likely to exacerbate existing inequalities in obesity and related health problems. Show more