Socioeconomic factors, body mass index and bariatric surgery: a Swedish nationwide cohort study

Memarian, Ensieh; Sundquist, Kristina; Calling, Susanna; Sundquist, Jan; Li, Xinjun

doi:10.1186/s12889-019-6585-8

Cited by 13 publications

(10 citation statements)

References 24 publications

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“…This study demonstrates, however, that sociodemographic inequalities associated with uncomplicated cystitis in women exist. This has also previously been shown in other recent studies in Sweden that have demonstrated associations between socioeconomic status, country of birth and geographic region with risks of negative outcomes of various medical conditions [31] , [32] , [33] , although these findings are not consistent [34] .…”

Section: Discussionsupporting

confidence: 59%

Sociodemographic factors and uncomplicated cystitis in women aged 15–50 years: a nationwide Swedish cohort registry study (1997–2018)

Jansåker

Sundquist

2021

The Lancet Regional Health - Europe

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Background Symptoms suggestive of uncomplicated cystitis constitutes one of the most common reasons to seek health care in otherwise healthy women. Previous studies regarding the relationship between sociodemographic factors and uncomplicated cystitis are limited, mainly because of the lack of nationwide population-based data from primary healthcare settings, where most uncomplicated cystitis are diagnosed. Methods A Swedish nation-wide open cohort study consisting of 2 044 065 females who were 15–50 years of age during the study period (1997–2018) was conducted. The outcome was first event uncomplicated cystitis diagnosed in primary health care rather than an assessment of the "true" incidence, which is not feasible in nationwide datasets. Cox regression models were used in the statistical analyses. Findings The study identified 546 076 first events of uncomplicated cystitis (26•7% of the study population), corresponding to an incidence rate per 100 person-years of 2•91 (95% CI 2•90–2•91). In fully adjusted models, rural living was associated with lower risks of uncomplicated cystitis (Hazard ratio, HR, 0•67; 95% CI, 0•66–0•68) compared to urban living, while both Middle Eastern/North African (HR, 1•15; 95% CI, 1•14–1•16) and Latin American/Caribbean (HR, 1•24; 95% CI, 1•22–1•27) women had higher risks compared to Swedish women. Low education and low income were also associated with higher risks compared to high education and high income. Interpretation This study presents novel risk factors associated with uncomplicated cystitis in women. The findings may help health care workers in the treatment of women with symptoms of uncomplicated cystitis. Funding The Primary Healthcare Management and ALF funding (Region Skåne, Sweden) and the Swedish Research Council.

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Section: Discussionsupporting

confidence: 59%

Sociodemographic factors and uncomplicated cystitis in women aged 15–50 years: a nationwide Swedish cohort registry study (1997–2018)

Jansåker

Sundquist

2021

The Lancet Regional Health - Europe

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“…We did not identify an association between bariatric surgery and SES, which may imply that within the Swedish healthcare system, bariatric surgery is equally available for everyone who fulfills the surgical criteria, as suggested by a previous study [32]. In the present study, individuals with a nonNordic origin were slightly more likely to undergo bariatric surgery, which may be related to hereditary factors.…”

Section: Discussioncontrasting

confidence: 57%

High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity

Brissman

Lindberg

Beamish

et al. 2021

Surgery for Obesity and Related Diseases

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Background: Despite the modest effects of behavioral treatment on obesity in adolescence, bariatric surgery is rarely performed. Obesity often persists from childhood to adulthood, but it is not known how many individuals proceed with bariatric surgery in young adulthood. Objective: The aim of this study was to determine what proportion of individuals who received pediatric behavioral obesity treatment subsequently underwent bariatric surgery in early adulthood, and to identify predictors thereof. Setting: National registries, Sweden. Methods: In this prospective cohort study, the Swedish Childhood Obesity Treatment Register was linked to several national registers. Results: The childhood obesity cohort included 6502 (45% females) with a median age at follow-up of 21.7 years (interquartile range [IQR] 5.2). Of these, 8.2% underwent bariatric surgery at a median age of 20.9 years (IQR 4.2). The estimated cumulative incidence of bariatric surgery at age 30 was 21.5%. Obesity-related co-morbidities were identified in 31.7% before bariatric surgery in the childhood obesity cohort. Predictors of bariatric surgery were female sex, high body mass index standard deviation score (BMI SDS) at the start and end of treatment, poor treatment response, as well as own or parental cardiometabolic disease. Conclusions: More than a fifth are estimated to undergo bariatric surgery in early adulthood, despite having received pediatric behavioral obesity treatment. Our results indicate that for many children, behavioral treatment is insufficient in reducing obesity and preventing obesity-related co-morbidity. Therefore, it is reasonable to assume that more effective treatment of adolescents with severe obesity, including more rigorous behavioral support and pharmacologic treatment, but also more frequent use of bariatric surgery, would benefit this group of patients.

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“…Although severe and complex obesity is equally common among men and women in Sweden [ 14 ], the majority (75%) of those who undergo bariatric surgery in Sweden are women [ 14 – 17 ]. According to a global report from 51 countries the proportion of female patients undergoing bariatric surgery 2014–2018 was 73.7% [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Primary care physicians’ knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns: a Swedish survey study

et al. 2021

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Background Obesity prevalence is increasing globally. Bariatric surgery is an effective treatment for severe and complex obesity resulting in significant and sustained weight loss. In Sweden, most bariatric surgery patients are referred by primary care physicians. We aimed to explore barriers for physicians to refer patients with severe and complex obesity for bariatric surgery. Methods A questionnaire survey was in 2019 emailed to 1100 primary care physicians in the Skåne and Kronoberg regions in south Sweden. The survey focused on referral patterns, knowledge and attitudes towards bariatric surgery and concerns about postoperative complications. We created different statistical indices for referral patterns, knowledge, attitudes and concerns about bariatric surgery. To analyze the correlation between these indices, we did Spearman’s correlations and regression analyses. Results Of 1100 email respondents, we received 157 (14%) completed surveys. Among 157 physician respondents, 73% answered that they had good knowledge about the referral criteria for bariatric surgery, whereas 55 and 60% answered correctly to two items on criteria for bariatric surgery. A majority of respondents (84%) stated that their patients initiated referral to bariatric surgery. Half of the respondents had concerns about postoperative medical and surgical complications, but another half had a positive attitude to bariatric surgery as a treatment for obesity comorbidities. Almost half of the respondents (44%) answered that they needed to learn more about bariatric surgery. We found significant positive correlations between high knowledge and referral patterns (r = 0.292, p < 0.001) and positive attitudes (r = 0.235, p < 0.001) respectively. We found significant reverse correlations between concerns and referral patterns (r = − 0.355, p < 0.001) and between positive attitudes and concerns (r = − 0.294, p < 0.001). In logistic regression high levels of concerns explained low willingness to refer for bariatric surgery (Odds Ratio 0.2, 95% confidence interval 0.1–0.7). Conclusion According to this Swedish survey among primary care physicians, high levels of concerns about bariatric surgery among physicians seemed to be a barrier to refer patients with severe and complex obesity for bariatric surgery. Since high knowledge about obesity and bariatric surgery correlated negatively to concerns and positively to favorable attitudes to bariatric surgery, more knowledge about obesity and bariatric surgery is warranted.

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Socioeconomic factors, body mass index and bariatric surgery: a Swedish nationwide cohort study

Cited by 13 publications

References 24 publications

Sociodemographic factors and uncomplicated cystitis in women aged 15–50 years: a nationwide Swedish cohort registry study (1997–2018)

Sociodemographic factors and uncomplicated cystitis in women aged 15–50 years: a nationwide Swedish cohort registry study (1997–2018)

High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity

Primary care physicians’ knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns: a Swedish survey study

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