Regional Variation in Unmet Need for Metabolic Surgery in England: a Retrospective, Multicohort Analysis

Area of Science:

• Public Health
• Bariatric Surgery
• Health Services Research

Background:

• Despite strong evidence supporting metabolic surgery, its provision remains limited in England.
• A significant gap exists between the number of individuals eligible for and those receiving metabolic surgery.

Purpose of the Study:

• To estimate the population eligible for metabolic surgery in English regions.
• To quantify the unmet need for metabolic surgery services.
• To identify factors associated with eligibility for metabolic surgery.

Main Methods:

• Utilized Health Survey for England, National Diabetes Audit, and population estimates to determine eligibility.
• Analyzed Hospital Episode Statistics (2013-2019) for metabolic surgery procedure volumes by region.
• Employed regression analysis to identify factors linked to metabolic surgery eligibility.

Main Results:

• Approximately 7.3% of the English population (3.21 million people) are potentially eligible for metabolic surgery.
• Less than 0.20% of eligible individuals received metabolic surgery annually, with significant regional disparities (0.08%-0.41%).
• Eligibility was higher among females, older individuals, those with fewer educational qualifications, and residents of deprived areas.

Conclusions:

• A substantial eligible population for metabolic surgery exists in England, indicating a large unmet need.
• Significant regional variations in metabolic surgery provision require further investigation and targeted interventions.
• Understanding demographic and socioeconomic factors associated with eligibility can inform service planning and reduce health inequalities.