The relationship between relative deprivation and access to bariatric surgery

Introduction: Adults living in the most deprived areas of England are more likely to have obesity. However, it is not clear whether social deprivation has an impact on accessing and the outcomes of bariatric surgery. The aim of our study was to explore the effect of indices of deprivation on access to bariatric surgery and its outcomes.

Methods: Cross-sectional prospective evaluation in a single centre in England of all patients who underwent primary bariatric surgery in 2016. Deprivation was assessed using the index of multiple deprivation (IMD) (2015), which ranks areas within England from the most (IMD Decile=1) to least deprived (IMD Decile=10). We extracted lower-layer super output area IMD Deciles according to the patients post code at time of bariatric surgery as well as the 12-month post-surgical weight loss and type of surgery.

Results: Of the 183 patients who underwent bariatric surgery, 55% (n=102) lived in areas within the 1-3rd IMD Decile (most deprived areas) (27% (4-6th) and 17% (7-10th) IMD Decile). There was no relationship between the type of bariatric surgery offered and IMD Decile. There was no relationship between IMD Decile tertiles (1-3,4-7, 7-10) and % weight loss at one year either across all bariatric surgical interventions (r2=0.019, P=0.09; r2=0.012, P=0.17) or when analysed according to surgery type.

Conclusions: People undergoing bariatric surgery typically lived in more deprived areas which might be anticipated by the correlation between deprivation and obesity as well as the relative levels of deprivation within our catchment area suggesting by this measure that deprivation is not a clear barrier to accessing bariatric surgery, however data was not available on patients who did not undergo surgery and this may reveal potential inequalities with accessing bariatric surgery both at the point of referral from primary care as well as in the transition from Tier 3 to Tier 4 services. Deprivation does not seem to have an effect on weight loss at 1 year post bariatric surgery. This data suggests that the bariatric surgery service is accessible to people across all IMD Deciles within our catchment area.