title: Socioeconomic deprivation remains a significant barrier in the choice of bariatric surgery even when full medical expense coverage is present.
abstract: BACKGROUND
  The prevalence of obesity is increasing in the socioeconomically deprived sector of the French population.
  
  
  OBJECTIVE
  Our objective was to assess whether the presence of a socioeconomic gradient could affect access to bariatric surgery in a publicly funded healthcare system with full medical expense coverage.
  
  
  METHODS
  The study was conducted at a general hospital and a health examination center.
  
  
  METHODS
  We prospectively included 100 patients who were admitted to the hospital for a preoperative bariatric surgery evaluation. As a reference group, we included 578 patients from the same area with body mass index (BMI) values≥35 kg/m² who visited the health center for regular medical, cardiovascular checkups. The patients were required to complete the Evaluation of Precariousness and Health Inequalities in Health Examination Centers (EPICES) questionnaire to investigate deprivation (deprivation cutoff≥30.17).
  
  
  RESULTS
  A total of 94 patients had complete data, with a mean EPICES score of 37.7±19.1 (P<.001). Patients were younger (mean age 39.2±12.7 years, P<.001), had a stronger female predominance (87%, P = .030), and higher mean BMI (43.3±6.9 kg/m², P<.001) than the reference group and were less socioeconomically deprived (64% versus 82% in the reference group, P<.001). No significant correlations existed among BMI, participant age, and deprivation score. In a subsequent age- and BMI-matched analysis, bariatric surgery candidates exhibited lower levels of deprivation.
  
  
  CONCLUSIONS
  The presence not only of material (e.g., coverage for medical expenses) but also social support is an important step toward the acceptance of bariatric surgery by morbidly obese patients.
authors.affiliation: Diabetes, Endocrinology and Nutrition Department, Hôpital AVICENNE - Paris XIII, BOBIGNY, France.
authors.forename: Marinos
authors.initials: M
authors.lastname: Fysekidis
authors.affiliation: Surgery Departement, Centre hospitalier de SAINT-DENIS, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Catheline
authors.affiliation: Health Center CPAM, Bobigny, France.
authors.forename: Narcisse
authors.initials: N
authors.lastname: Kouacou
authors.affiliation: Diabetes, Endocrinology and Nutrition Department, Hôpital AVICENNE - Paris XIII, BOBIGNY, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Bihan
authors.affiliation: Diabetes and Endocrinology Department, Centre Hospitalier de SAINT-DENIS, France. Electronic address: regis.cohen@ch-stdenis.fr.
authors.forename: Regis
authors.initials: R
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003657:Decision Making; D005260:Female; D005602:France; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012737:Sex Factors; D012944:Social Support; D012959:Socioeconomic Factors; D019472:Universal Health Insurance / Q000706:statistics & numerical data*
keywords: Bariatric surgery; Deprivation; EPICES; Morbid obesity