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Access to surgery

Little difference in access to surgery in Sweden on socioeconomic status

The prevalence of individuals with low income, low education, no employment and who were single were highest in the BMI30–39 and >40 groups

There is very little difference in access to bariatric surgery in Sweden with regards to socioeconomic status among patients with BMI>40, according to researchers from Lund University, Lund, Sweden. Although some differences were found in favour of those with a low socioeconomic status, the investigators concluded that this “indicates that the Swedish healthcare system seems to have achieved equal access to health care for bariatric surgery.” The authors noted that this is the first nationwide study that considers socioeconomic characteristics in relation to rates of bariatric surgery, including levels of BMI.

The paper, ‘Socioeconomic factors, body mass index and bariatric surgery: a Swedish nationwide cohort study’, published in BMC Public Health, investigated if there is an association between socioeconomic factors and bariatric surgery by taking BMI into account. The researchers collected data from 2005 to 2012 from the Swedish Inpatient Register and included 7,433 women and 1,961 men who underwent bariatric surgery.

The researchers calculated family income and classified patients as low income, middle income (50% of the study population) and high income – the researchers also included educational attainment and employment status. Patients were subsequently divided into the four BMI groups according to the WHO classification.

Outcomes

Both women and men, the prevalence of individuals with high income, high education, employment and who were married/cohabiting was highest in the group with BMI<25. In contrast, the prevalence of individuals with low income, low education, no employment and who were single were highest in the BMI30–39 and >40 groups.

For women, the HRs for bariatric surgery were higher for low and middle levels of income and education compared to high income and educational levels. The HRs were also higher for those who were employed and/or were married/cohabiting. After controlling for the other individual factors, the highest HR for bariatric surgery was found among those with a high income. Low and middle levels of education were strongly associated with bariatric surgery for a middle educational level. As in women, the highest HRs were found in those who were employed and/or were married/cohabiting.

In those with BMI>40, none of the socioeconomic variables were associated with bariatric surgery, except for middle educational level in women. In those with BMI30–39, women had higher HRs for low and middle family income and education. Those women who were single had a lower HR than those who were married/cohabiting. For men, the HR was significantly higher for low and middle education. The effect of BMI on surgery for men was modified by marital status, those who were married had a higher rate of surgery.

“The present nationwide study shows differences between socioeconomic groups and rates of bariatric surgery, favouring those with a low socioeconomic status,” the authors concluded. “However, socioeconomic differences disappeared in those individuals with a BMI>40, which indicates that severe obesity rules out socioeconomic differences in bariatric surgery rates. The Swedish healthcare system seems to have achieved its goal of equal health care for the entire population regarding bariatric surgery.”

To access this paper, please click here

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