Bariatric surgery (commonly known as weight loss surgery) helps patients with obesity lose weight. It is very effective and helps prevent heart disease and death. Some medicines can also help with weight loss. Research done in other countries suggests that people from more deprived backgrounds or from certain ethnic groups might have less access to bariatric surgery even though they are more likely to have obesity. We want to know whether people from poorer backgrounds and those belonging to non-white ethnic groups in the UK are less likely to have bariatric surgery or receive weight loss medications. We will also check if where people live in the UK affects the chances of them receiving these treatments. We will look at the chances of people with obesity receiving these treatments each year from 2010-2021 so we can if the situation is getting better or worse over time.
This research will help design future work looking to improve fair access to effective treatments for obesity as well as help policy makers and funders plan weight management services to provide care for patients most in need.
Obesity and its associated comorbidities are related to deprivation and certain ethnicities, though whether these groups access bariatric surgery or weight loss medications within the UK is uncertain. In this project, our primary aim is to assess the relationships between social deprivation and ethnicity and the likelihood of receiving bariatric surgery in the UK. To determine if any differences are unique to bariatric surgery or to weight loss treatment more generally we will also look at rates of prescribing Orlistat (a weight loss medication).
The study population is people with obesity and eligible for bariatric surgery (body mass index (BMI) ≥ 40 AND BMI ≥ 35 kg/m2 with either type 2 diabetes OR hypertension). CPRD Gold and Aurum will be used with an estimated feasibility count of 7500 bariatric surgeries across the study period of 2010-2021. In our retrospective cohort study we will calculate crude and adjusted hazard ratios (adjHRs) and 95% CIs of bariatric surgery AND/OR orlistat prescription in each 12 month period using a Cox proportional hazards regression model from 2010 to 2021. Calculation of rates of bariatric surgery will be estimated per 10,000 person-years at risk (PYAR) for each year. Rates by calendar year will be calculated by restricting the person years of follow-up to each year in question. Rates by ethnicity, socioeconomic group, geographical location (North East and North Cumbria, North West Coast, Yorkshire and Humber etc) will also be calculated with missing data separately categorised. The same analysis will be undertaken for Orlistat prescription.
Due to the nature of this health data research project the cause of any identified differences will be assessed in subsequent work further designed to ensure equitable access to treatment.
Primary outcomes:
Bariatric surgery,
Orlistat prescription
Exploratory outcomes:
Referral to weight management lifestyle interventions
Krishnarajah Nirantharakumar - Chief Investigator - University of Birmingham
Jonathan Hazlehurst - Corresponding Applicant - University of Birmingham
Francesca Crowe - Collaborator - University of Birmingham
Krishna Gokhale - Collaborator - University of Birmingham
PUSHPA SINGH - Collaborator - University of Birmingham
Srikanth Bellary - Collaborator - Aston University, Birmingham
Toby Helliwell - Collaborator - Keele University
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation