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Disparities in Receipt of Bariatric Surgery in Canada

An Analysis of Data From an Ontario Bariatric Surgery Referral Center

Zhang, Joyce C. BSc Pharm, MD*; Tomlinson, George PhD; Wnuk, Susan PhD; Sockalingam, Sanjeev MD‡,§; Cram, Peter MD, MBA*,∥

doi: 10.1097/MLR.0000000000001163
Original Articles

Background: Patients with lower socioeconomic status (SES) in the United States have reduced access to many health services including bariatric surgery. It is unclear whether disparities in bariatric surgery exist in countries with government-sponsored universal health benefits. The authors used data from a large regional Canadian bariatric surgery referral center to examine the relationship between SES and receipt of bariatric surgery.

Methods: The Toronto Western Hospital bariatric surgery registry was used to identify all adults referred for bariatric surgery assessment from 2010 to 2017. The authors compared demographics, SES measures, and clinical measures among patients who did not and did undergo bariatric surgery (Roux-en-Y or sleeve gastrectomy). Multiple logistic regression was used to examine differences in receipt of bariatric surgery according to patient demographic characteristics and SES factors.

Results: Among 2417 patients included in the study, 646 (26.7%) did not receive surgery and 1771 patients (73.2%) did. Patients who did not undergo surgery were more likely to be male individual (29.1% vs. 19.3%; P<0.001), black (12.1% vs. 8.3%; P=0.005), South Asian/Middle Eastern (8.2% vs. 4.5%; P<0.001), and less likely to be white (68.9% vs. 76.7%; P<0.001). In multiple logistic regression, factors associated with not receiving surgery were male sex, Black and South Asian/Middle Eastern ethnicity, being single, lack of employment, and history of psychiatric illness.

Conclusions: Among patients referred for bariatric surgery, those who were male individuals, nonwhite, single, and unemployed were less likely to undergo surgery. Our results suggest that even with equal insurance, there are disparities in receipt of bariatric surgery.

*Department of Medicine, University of Toronto

Biostatistics Research Unit

Department of Psychiatry, Toronto Western Hospital, Bariatric Surgery Program, University Health Network, University of Toronto

§Centre for Addiction and Mental Health

Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON, Canada

P.C. holds funding from National Institutes of Health. The remaining authors declare no conflict of interest.

Reprints: Joyce C. Zhang, BSc Pharm, MD, Department of Occupational Medicine, St Michael’s Hospital, 30 Bond Street, Toronto, ON, Canada M5B 1W8. E-mail:

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