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Postcode lottery

Statistical evidence of ‘postcode lottery’ for surgery in the UK

This study provides the first statistical evidence of the possibility of a ‘postcode lottery’ in the provision of bariatric surgery in the UK

Where a patient lives can significant impact access to bariatric surgery and social deprivation can influence the likelihood of receiving bariatric surgery in one region of the UK but not in another, according to the outcomes of a study. The research was presented at the 6th Annual Meeting of the British Obesity and Metabolic Surgical Society 21-23 January, in Newcastle, UK. 

“Bariatric surgery in the UK is delievered via specialist regional centres, although there is concern that a ‘postcode lottery’ exists in access to bariatric surgery in the UK despite NICE guidance,” said Shivam Bhanderi from the College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK. “The aim of this study was to investigate the effect of social deprivation on provision of bariatric surgery across two UK regions."

Shivam Bhanderi

Bhanderi  and colleagues retrospectively collected data from all patients who resided within a predetermined catchment area around each of the two study centres (West Midlands (Centre 1) and Somerset (Centre 2)) and had received a bariatric operation between 2003 and 2013 and the Index of Multiple Deprivation (IMD 2010) was used to compare regional social deprivation rates. Local obesity prevalence rates were obtained using data from Public Health England 2006 and cases were plotted onto maps displaying obesity prevalence and deprivation to visualise their geographical distribution. Patients were split into three tertiles of deprivation (high, median, low). A generalised linear model was generated for each tertile to investigate the effect of social deprivation on the relationship between bariatric case count and prevalence of obesity.

A total of 1,163 bariatric cases (414 from Centre 1 and 749 from Centre 2, 77.2% female in total). The median BMI of patients treated at Centre 1 was significantly higher than at Centre 2 (48.8kg/m2 v 52.0kg/m2, p<0.01). Local obesity rates around Centre 1 were found to be higher than around Centre 2 (p<0.05) and there was also a higher level of social deprivation around Centre 1. Incidence rate ratios (IRRs) were calculated using generalised linear models. For Centre 1, higher levels of social deprivation increased the dependence of bariatric cases on obesity prevalence (p<0.001) and the effect of social deprivation at Centre 2 was less than Centre 1 (p<0.001).

“This study provides the first statistical evidence of the possibility of a ‘postcode lottery’ in the provision of bariatric surgery in the UK,” he concluded. “Further research is required to establish causes for this disparity in order to ensure adequate and equal access to bariatric surgery.”

Co-authors of this study were Jacob Matthews1, Mushfique Alam1, Gavin Rudge2, Hamish Noble3, Rajwinder Nijjar4, David Mahon3, Martin Richardson4, Paul Super4, Richard Welbourn3, Rishi Singhal4 (1College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK, 2Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK, 3Bariatric Unit, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, UK, 4Upper GI & Bariatric Unit, Heart of England NHS Foundation Trust, Birmingham, UK)

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