Sociodemographic Differences and Time Trends of Bariatric Surgery in Sweden 1990–2010
The aim of the present study was to examine demographic and socioeconomic differences and time trends of bariatric surgery in Sweden during 1990–2010.
An open cohort of all individuals aged 20–64 years was followed between 1990 and 2010. Socioeconomic differences were examined during two periods: 1990–2005 and 2006–2010 using cumulative rates in a closed cohort. Hazard ratios (HRs) of bariatric surgery were calculated in these two periods using Cox regression models.
A majority of the 22,198 individuals that underwent bariatric surgery were women (76.3 %). Women were more likely to undergo surgery in younger ages (30–39 years), while men were more likely to undergo surgery around 10 years later (40–49 years). The number of surgeries increased substantially during the second period. During the whole period, the dominating surgical method was gastric bypass contributing to 69.4 % of the procedures. HRs for bariatric surgery were highest for individuals with intermediate educational level and intermediate-low income in both periods. For married/cohabiting and/or employed individuals, the HRs were highest during the first period whereas an opposite pattern was seen in the second period.
Individuals in the lowest socioeconomic groups undergo bariatric surgery less often than those with intermediate income and educational level, although previous research has shown that those with low socioeconomic status have the highest rates of morbid obesity. The failure to identify eligible individuals for surgery may result in negative effects on those individuals with the largest need for weight loss.
KeywordsObesity Bariatric surgery Socioeconomic differences Time trends
This work was supported by grants to Dr Kristina Sundquist and Dr Jan Sundquist from the Swedish Research Council as well as ALF funding from Region Skåne awarded to Kristina Sundquist and Jan Sundquist.
Conflict of Interest
There are no competing interests.
- 2.Welfare SNBoHa. National Public Health Report 2009 (Folkhälsorapport 2009). Stockholm: Swedish National Board of Health and Welfare; 2009.Google Scholar
- 4.Obesity: preventing and managing the global epidemic. World Health Organization; 2000. pp. 252, http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/index.html.
- 5.Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. National Heart, Lung and Blood Institute, National institute of Health; 1998.Google Scholar
- 6.Economics OoH. Shedding the pounds. Obesity management, NICE guidance and bariatric surgery in England. 2010. 2012. Accessed at www.ohe.org.
- 8.Atkinson RL, Dietz WH, Foreyt JP, et al. Very low-calorie diets. National Task Force on the Prevention and Treatment of Obesity, National Institutes of Health. JAMA 1993;270:967–74.Google Scholar
- 18.National Board of Health and Welfare. Validity of the diagnoses from the Swedish in-care Register 1987 and 1995. (In Swedish: Värdering av diagnoskvaliteten för akut hjärtinfarkt i patientregistret 1987 och 1995): Epidemiologiskt Centrum, Socialstyrelsen; 2000.Google Scholar
- 20.International Classification of Diseases (ICD). World Health Organization: http://www.who.int/classifications/icd/en/.
- 22.Age standardization of rates: a new WHO standard: World Health Organization. 2001. www.who.int/healthinfo/paper31.pdf
- 23.SAS Institute Inc. SAS 9.3. NC, USA: SAS Institute Inc.; 2011.Google Scholar
- 24.Yearly report 2011. (Årsrapport 2011) Scandinavian obesity surgery registry (SOREG). 2011. http://www.ucr.uu.se/soreg/index.php/dokument/cat_view/58-dokument/57-arsrappoerter.
- 31.Sjöberg. Have lifestyles improved? Statistics Sweden’s survey of living conditions (Har levnadsvanorna förbättrats? SCB undersökning om levnadsförhållanden) (ULF). Stat Swed J (Statistiska Centralbyråns tidskrift) 2000;2.Google Scholar