Influence of social deprivation on provision of bariatric surgery: 10-year comparative ecological study between two UK specialist centres
| Autor: | Jacob H Matthews, Martin Richardson, Shivam Bhanderi, Rishi Singhal, Hamish Noble, Paul Super, David Mahon, Mushfique Alam, Richard Welbourn, Gavin Rudge |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Population Psychological intervention Bariatric Surgery 030209 endocrinology & metabolism Health Services Accessibility surgery 03 medical and health sciences social medicine 0302 clinical medicine Health Economics Catchment Area Health Residence Characteristics Poverty Areas Medicine Humans 030212 general & internal medicine Obesity education Socioeconomic status Retrospective Studies education.field_of_study Health economics business.industry Public health Research public health Ecological study General Medicine Middle Aged medicine.disease United Kingdom Surgery Social deprivation Cross-Sectional Studies Female business |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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