Impact of socioeconomic status and urbanicity on healthcare utilization following bariatric surgery: a Canadian population-based cohort study.

INTRODUCTION

Bariatric surgery is considered the most effective treatment for obesity resulting in long-term weight loss and comorbidity resolution. Prior studies have examined the effect of socioeconomic status (SES) and urbanicity on weight loss and short-term outcomes. However, there is little data on the impact of SES and urbanicity on long-term healthcare utilization following bariatric surgery. The objective of this population-based study is to compare healthcare utilization in the years following bariatric surgery based on income quintile and urbanicity.

METHODS

All patients enrolled in the Centre for Metabolic and Bariatric Surgery (CMBS) who underwent laparoscopic gastric bypass or sleeve gastrectomy between 2013 and 2019 in Manitoba were included. Demographic information and healthcare utilization information were obtained from the Manitoba Population Research Data Repository, which is housed at the Manitoba Centre for Health Policy (MCHP). Income quintiles and area of living were determined using postal code of residence. Healthcare encounters measured included hospitalizations, general practitioner visits, specialist visits, CT scans, upper endoscopy, and number of outpatient prescription dispensations. All encounters were measured at 3 and 5 years before and after the time of bariatric surgery.

RESULTS

1184 patients were included in this review, 478 living in a rural setting and 706 in an urban setting. In the 5 years preceding bariatric surgery, there were no differences in the rates of polypharmacy, imaging, or endoscopy use between income quintiles among the rural population, while lower income quintiles experienced higher rates of hospitalization (p < 0.001) and GP visits (p < 0.001). At 5 years after bariatric surgery, only GP visits (higher among lower income, p < 0.001) and specialist visits (higher among higher income, p < 0.001) were different within the rural population. Among the urban population, in the 5 years preceding bariatric surgery lower income was associated with increased rates of polypharmacy (p = 0.001), imaging use (p = 0.004), and GP visits (p < 0.001). At 5 years after bariatric surgery, lower income in the urban population was associated with increased rates of polypharmacy (p < 0.001), imaging use (p < 0.001), and GP visits (p < 0.001) along with higher rates of upper endoscopy (p < 0.001) and hospitalization (p = 0.02).

CONCLUSIONS

Low-income patients living in an urban setting have the highest rates of healthcare utilization at 5 years following bariatric surgery. These results are suggestive of a disparity in long-term outcomes based on SES and urbanicity. Future studies are needed to determine the underlying reasons for the increased healthcare utilization among urban, low-income patients and strategies to address them.