Ethnic Disparities in Access to Publicly Funded Bariatric Surgery in South Auckland, New Zealand
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Ethnic Disparities in Access to Publicly Funded Bariatric Surgery in South Auckland, New Zealand Jamie-Lee Rahiri 1 & Christin Coomarasamy 2 & Andrew MacCormick 1 & Matire Harwood 3 & Andrew Hill 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background In New Zealand (NZ), Indigenous Māori and Pacific peoples experience a higher burden of obesity and obesityrelated disease. Counties Manukau Health (CMH) provides the largest public bariatric service in NZ housing a higher proportion (64%) of non-European groups (Asian, Pacific and Māori). This study investigated whether ethnic disparities in the receipt of bariatric surgery exist within one of the most ethnically diverse populations in NZ. Methods All patients accepted on to the CMH bariatric programme between 1 January 2011 and 31 December 2017 were identified through hospitalisation records. Logistic regression modelling with multivariate adjustment was utilised to assess the likelihood (odds ratio) of receipt of bariatric surgery by ethnicity. Results A total of 2519 referrals were received, of which 1051 proceeded to surgery. The proportion of patients referred who eventually underwent bariatric surgery was significantly higher for Other Europeans (68%) and NZ Europeans (63%) compared to Asian (42%), Māori (41%) and Pacific peoples (28%, p < 0.05). The likelihood of receipt of bariatric surgery was significantly lower for Māori (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42–0.68) and Pacific (OR, 0.3; 95%CI, 0.23–0.40). These disparities were not explained by differences in socio-demographics, comorbidity or attrition. Conclusions Ethnic disparities in the receipt of publicly funded bariatric surgery exist where NZ European and Other European patients are more likely to gain access to publicly funded bariatric surgery. These findings challenge current selection criteria and prompt discussion around whether equity targets based on ethnicity need to be established. Keywords Ethnicity . Publicly funded . Bariatric surgery . Indigenous health
Introduction Bariatric surgery is available in New Zealand (NZ) through the private and public health sectors. Publicly funded bariatric surgery in NZ has been available since 2004 [1, 2]. A public awareness campaign promoting bariatric surgery as the most effective intervention for weight loss was fronted in NZ by Indigenous Māori leaders [3]. However, access to bariatric
* Jamie-Lee Rahiri [email protected] 1
Department of Surgery, South Auckland Clinical Campus, The University of Auckland, c/- Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
2
Research and Evaluation Office, Ko Awatea, Middlemore Hospital, Auckland, New Zealand
3
Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
surgery through the public system is restricted by limited government funding and equitable selection of publicly funded bariatric surgery candidates remains a challenge [1, 2]. As su
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