BACKGROUND: Bariatric surgery has emerged as an effective and safe treatment for severe obesity and utilization rates have increased dramatically. In private health care settings, low socioeconomic status is associated with a reduced likelihood of undergoing a bariatric procedure. Whether this relationship is also present in a universally accessible, publicly funded health care system is not currently known. METHODS: A retrospective analysis of the Edmonton Weight Wise obesity program clinical registry was conducted. Patients who were unemployed, on long-term disability or receiving social assistance were classified as "low income" status. The remaining patients were categorized as "regular income" status. Multivariable logistic regression analysis was used to examine the association between low income status and approval for surgery within 1 year of program entry. RESULTS: Thirty-three (7%) of 419 patients were ineligible for surgery or excluded because of missing income status data. Of the remaining 386 patients, 72 (19%) were of low income status and 89 (23%) were approved for surgery. Low income patients were older, heavier, and had greater comorbidity. Compared to patients of regular income status, those with low income status were less likely to be approved for surgery (15.3% versus 24.8%; adjusted OR 0.45; 95% CI 0.22 to 0.94). CONCLUSIONS: Within a publicly funded and universally accessible regional obesity program, lower income status patients were less likely to be approved for bariatric surgery. Further study is necessary to clarify this apparent disparity and to determine if program modifications are necessary to ensure equity across all socioeconomic strata.
BACKGROUND: Bariatric surgery has emerged as an effective and safe treatment for severe obesity and utilization rates have increased dramatically. In private health care settings, low socioeconomic status is associated with a reduced likelihood of undergoing a bariatric procedure. Whether this relationship is also present in a universally accessible, publicly funded health care system is not currently known. METHODS: A retrospective analysis of the Edmonton Weight Wise obesity program clinical registry was conducted. Patients who were unemployed, on long-term disability or receiving social assistance were classified as "low income" status. The remaining patients were categorized as "regular income" status. Multivariable logistic regression analysis was used to examine the association between low income status and approval for surgery within 1 year of program entry. RESULTS: Thirty-three (7%) of 419 patients were ineligible for surgery or excluded because of missing income status data. Of the remaining 386 patients, 72 (19%) were of low income status and 89 (23%) were approved for surgery. Low income patients were older, heavier, and had greater comorbidity. Compared to patients of regular income status, those with low income status were less likely to be approved for surgery (15.3% versus 24.8%; adjusted OR 0.45; 95% CI 0.22 to 0.94). CONCLUSIONS: Within a publicly funded and universally accessible regional obesity program, lower income status patients were less likely to be approved for bariatric surgery. Further study is necessary to clarify this apparent disparity and to determine if program modifications are necessary to ensure equity across all socioeconomic strata.
Authors: Lars Sjöström; Anna-Karin Lindroos; Markku Peltonen; Jarl Torgerson; Claude Bouchard; Björn Carlsson; Sven Dahlgren; Bo Larsson; Kristina Narbro; Carl David Sjöström; Marianne Sullivan; Hans Wedel Journal: N Engl J Med Date: 2004-12-23 Impact factor: 91.245
Authors: Cynthia L Ogden; Margaret D Carroll; Lester R Curtin; Margaret A McDowell; Carolyn J Tabak; Katherine M Flegal Journal: JAMA Date: 2006-04-05 Impact factor: 56.272
Authors: Pierre-Yves Cremieux; Henry Buchwald; Scott A Shikora; Arindam Ghosh; Haixia Elaine Yang; Marric Buessing Journal: Am J Manag Care Date: 2008-09 Impact factor: 2.229
Authors: Sanjit K Bhogal; Jacinta I Reddigan; Ori D Rotstein; Ashley Cohen; Dresden Glockler; Andrea C Tricco; Janet K Smylie; Stephen A Glazer; Jason Pennington; Lesley Gotlib Conn; Timothy D Jackson Journal: Obes Surg Date: 2015-05 Impact factor: 4.129