Abstract
BACKGROUND: The aim of the present study was to examine demographic and socioeconomic differences and time trends of bariatric surgery in Sweden during 1990-2010. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.