Background To quantify inequalities in obesity-related complication (ORC) prevalence and differences in healthcare costs between the most (Q1) and least (Q5) deprived quintiles of people living with obesity. Methods Retrospective, open cohort study of ~2.5 million people residing in North-West London using linked primary and secondary electronic health records. Individuals aged ≥18 years living with obesity (body mass index ≥30 kg/m 2 ) between 1 January 2016 and 31 December 2019 were eligible. The population was stratified into deprivation quintiles per the Index of Multiple Deprivation (IMD). Individuals were grouped into non-mutually exclusive ORC prevalence groups covering 27 ORCs, including ORC multimorbidity. Primary outcomes were ORC prevalence and healthcare cost differences between the lowest and the highest deprivation quintiles. ORC prevalence and healthcare costs were age-standardised to the European Standard Population. Results Out of 362 023 people living with obesity, 64 866 were in IMD Q1 (most deprived) and 24 590 in Q5. The largest ORC prevalence differences between Q1 and Q5 were seen in conditions with highest prevalence overall: type 2 diabetes (5.1 percentage point prevalence difference; 19.5% prevalence), hypertension (3.8, 32.7%) and depression (3.4, 6.3%). The percentage point prevalence difference was larger with increasing ORC multimorbidity: 1.2 for at least one, 3.7 for at least two and 4.0 for at least three ORCs. Healthcare costs were greater in the most deprived quintile compared with the least deprived quintile for every ORC population, with the largest differences seen in peripheral arterial disease (£2801 cost difference), cancer (£2785), renal failure (£2108). Conclusions Targeted interventions proportionate to these health and cost burdens could improve health equity and reduce healthcare cost, yet their causal drivers require further study.
Lübker et al. (Thu,) studied this question.