Design, setting and participants: Prospective population-based cohort study of 49 364 individuals aged 45–74 years with body mass index (BMI) ≥ 30 kg/m2. Data from questionnaires (distributed from 1 January 2006 to 31 December 2008) were linked to hospital and death data to 30 June 2010. The sample was drawn from the 45 and Up Study (approximately 10% of New South Wales population aged 45 included, response rate approximately 18%).17
Results: Over 111 757 person-years (py) of follow-up, 312 participants had bariatric surgery, a rate of 27.92 per 10 000 py (95% CI, 24.91–31.19). Rates were highest in women, those living in major cities and those with diabetes, and increased significantly with a higher BMI and number of chronic health conditions. Adjusted RRs were 5.27 (95% CI, 3.18–8.73) for those with annual household income ≥ $70 000 versus those with household income < $20 000, and 4.01 (95% CI, 2.41–6.67) for those living in areas in the least disadvantaged quintile versus those in the most disadvantaged quintile. Having versus not having private health insurance (age- and sex-adjusted RR, 9.25; 95% CI, 5.70–15.00) partially explained the observed inequalities.
Conclusions: Bariatric surgery has been shown to be cost-effective in treating severe obesity and associated illnesses. While bariatric surgery rates in Australia are higher in those with health problems, large socioeconomic inequalities are apparent. Our findings suggest these procedures are largely available to those who can afford private health insurance and associated out-of-pocket costs, with poor access in populations who are most in need. Continuing inequalities in access are likely to exacerbate existing inequalities in obesity and related health problems.
- 1. Australian Bureau of Statistics. National health survey: summary of results, 2007-08 (Reissue). Canberra: ABS, 2009. (ABS Cat. No. 4364.0.) http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0 (accessed Aug 2012).
- 2. Organisation for Economic Co-operation and Development. Obesity and the economics of prevention: fit not fat. Paris: OECD, 2010. http://www.oecd.org/health/healthpoliciesanddata/obesityandtheeconomicsofpreventionfitnotfat. htm (accessed Aug 2012).
- 3. Walls H, Wolfe R, Haby MM, et al. Trends in BMI of urban Australian adults, 1980-2000. Public Health Nutr 2010; 13: 631-638.
- 4. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009; 9: 88.
- 5. Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083-1096.
- 6. National Institute for Health and Clinical Excellence. CG43 Obesity: full guideline. Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. NICE clinical guideline 43. London: NICE, 2006. http://guidance.nice.org.uk/CG43/Guidance (accessed Aug 2012).
- 7. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults. Canberra: NHMRC, 2003. http://health.gov.au/internet/main/publishing.nsf/Content/7AF116AFD4E2EE3 DCA256F190003B91D/$File/adults.pdf (accessed Aug 2012).
- 8. Lynch J, Belgaumkar A. Bariatric surgery is effective and safe in patients over 55: a systematic review and meta-analysis. Obes Surg 2012; 22: 1507-1516.
- 9. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 2009; 13: 1-190, 215-357, iii-iv.
- 10. Garb J, Welch G, Zagarins S, et al. Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg 2009; 19: 1447-1455.
- 11. Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 2007; 142: 621-632.
- 12. Dixon JB, Murphy DK, Segel JE, Finkelstein EA. Impact of laparoscopic adjustable gastric banding on type 2 diabetes. Obes Rev 2011; 13: 57-67.
- 13. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 2012; 366: 1577-1585.
- 14. Australian Institute of Health and Welfare. Weight loss surgery in Australia. Canberra: AIHW, 2010. (AIHW Cat. No. HSE 91.) http://www. aihw.gov.au/publication-detail/?id=6442472385&tab=2 (accessed Aug 2012).
- 15. Australian Institute of Health and Welfare. Who is overweight? Canberra: AIHW, 2011. http://www.aihw.gov.au/overweight-and-obesity/prevalence (accessed Aug 2012).
- 16. Talbot ML, Jorgensen JO, Loi KW. Difficulties in provision of bariatric surgical services to the morbidly obese. Med J Aust 2005; 182: 344-347. <MJA full text>
- 17. Banks E, Redman S, Jorm L, et al. Cohort profile: the 45 and up study. Int J Epidemiol 2008; 37: 941-947.
- 18. National Centre for Classification in Health. The international statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM). 3rd ed. Sydney: University of Sydney, 2002.
- 19. Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA) - Technical Paper 2006. Canberra: ABS, 2008. http://www. ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/72283F45CB86E5FECA 2574170011B271/$File/2039055001_socioeconomic%20indexes% 20for%20areas%20(seifa)%20-%20 technical %20paper_2006.pdf (accessed Aug 2012).
- 20. Australian Institute of Health and Welfare. Rural, regional and remote health: a guide to remoteness classifications. Canberra: AIHW, 2004. (AIHW Cat. No. PHE 53; Rural Health Series No. 4.) http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459567 (accessed Aug 2012).
- 21. Ng SP, Korda R, Clements M, et al. Validity of self-reported height and weight and derived body mass index in middle-aged and elderly individuals in Australia. Aust N Z J Public Health 2011; 35: 557-563.
- 22. Mealing NM, Banks E, Jorm LR, et al. Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs. BMC Med Res Methodol 2010; 10: 26.
- 23. Ponsonby AL, Dwyer T, Couper D. Is this finding relevant? Generalisation and epidemiology. Aust N Z J Public Health 1996; 20: 54-56.
- 24. House of Representatives Standing Committee on Health and Ageing. Weighing it up: obesity in Australia. Canberra: Commonwealth of Australia, 2009. http://www.aph.gov.au/Parliamentary_Business/Committees/House_of_Represen tatives_Committees?url=haa/./obesity/report. htm (accessed May 2012).
- 25. Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med 2011; 28: 628-64.
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