Table 4. RRs for NHS WM referral within adults eligible for WM referral in England with at least 2 years of follow-up data in CPRD GOLD (2007–2020)a (MODEL A).
| Eligible for a WM referral (N =) | Had a WM referral recorded (N =) (% of those eligible) | Crude RR (95% CI) | P value | Adjusted RR (95% CI)b | P value | |
|---|---|---|---|---|---|---|
| Total | 1,751,385 | 53,270 (3.04) | 1,751,385c | 1,228,024d | ||
| Sex e | ||||||
| Male | 795,602 | 17,896 (2.25) | 0.61 (0.60,0.62) | <0.001 | 0.69 (0.68,0.71) | <0.001 |
| Female | 955,783 | 35,374 (3.70) | 1.0 | 1.0 | ||
| Age group at diagnosis with overweight or obesity | ||||||
| 18–24 | 107,515 | 2,464 (2.29) | 0.54 (0.52,0.57) | <0.001 | 0.52 (0.49,0.55) | <0.001 |
| 25–34 | 206,868 | 5,342 (2.58) | 0.61 (0.59,0.63) | <0.001 | 0.59 (0.57,0.62) | <0.001 |
| 35–44 | 295,335 | 12,174 (4.12) | 0.98 (0.96,1.00) | 0.072 | 0.95 (0.93,0.98) | 0.001 |
| 45–54 | 351,288 | 14,796 (4.21) | 1.0 | 1.0 | ||
| 55–64 | 338,340 | 11,998 (3.55) | 0.84 (0.82,0.86) | <0.001 | 0.91 (0.89,0.94) | <0.001 |
| 65–74 | 269,041 | 5,695 (2.12) | 0.50 (0.49,0.52) | <0.001 | 0.60 (0.58,0.62) | <0.001 |
| 75+ | 182,998 | 801 (0.44) | 0.10 (0.10,0.11) | <0.001 | 0.15 (0.13,0.16) | <0.001 |
| Strategic Health Authority of GP practice | ||||||
| North East | 39,114 | 1,397 (3.57) | 1.24 (1.17,1.31) | <0.001 | 1.60 (1.50,1.70) | <0.001 |
| North West | 271,163 | 7,826 (2.89) | 1.0 | 1.0 | ||
| Yorkshire and the Humber | 63,586 | 751 (1.18) | 0.41 (0.38,0.44) | <0.001 | 0.61 (0.56,0.65) | <0.001 |
| East Midlands | 62,955 | 1,825 (2.90) | 1.00 (0.96,1.06) | 0.863 | 1.61 (1.52,1.70) | <0.001 |
| West Midlands | 237,361 | 12,828 (5.40) | 1.87 (1.82,1.92) | <0.001 | 2.17 (2.10,2.24) | <0.001 |
| East of England | 169,466 | 1,762 (1.04) | 0.36 (0.34,0.38) | <0.001 | 0.43 (0.41,0.46) | <0.001 |
| South West | 196,943 | 4,613 (2.34) | 0.81 (0.78,0.84) | <0.001 | 0.98 (0.94,1.02) | 0.235 |
| South Central | 237,355 | 6,566 (2.77) | 0.96 (0.93,0.99) | 0.010 | 1.21 (1.17,1.26) | <0.001 |
| London | 214,783 | 5,836 (2.72) | 0.94 (0.91,0.97) | <0.001 | 1.11 (1.06,1.15) | <0.001 |
| South East Coast | 258,659 | 9,866 (3.81) | 1.32 (1.28,1.36) | <0.001 | 1.64 (1.59,1.70) | <0.001 |
| Rural–urban classification of GP practice | ||||||
| Urban | 1,196,702 | 35,217 (2.94) | 1.0 | 1.0 | ||
| Rural | 180,091 | 4,376 (2.43) | 0.83 (0.80,0.85) | <0.001 | 0.88 (0.85,0.90) | <0.001 |
| Data missing/not recorded | 374,592 | 13,677 (3.65) | - | - | ||
| Year of diagnosis with overweight/obesity | ||||||
| 2007 | 531,157 | 16,637 (3.13) | 1.0 | 1.0 | ||
| 2008 | 271,624 | 7,842 (2.89) | 0.92 (0.90,0.95) | <0.001 | 0.95 (0.93,0.98) | 0.003 |
| 2009 | 192,610 | 5,447 (2.83) | 0.90 (0.88,0.93) | <0.001 | 0.93 (0.89,0.96) | <0.001 |
| 2010 | 154,843 | 3,807 (2.46) | 0.78 (0.76,0.81) | <0.001 | 0.85 (0.81,0.88) | <0.001 |
| 2011 | 131,933 | 3,352 (2.54) | 0.81 (0.78,0.84) | <0.001 | 0.89 (0.85,0.93) | <0.001 |
| 2012 | 123,252 | 3,380 (2.74) | 0.88 (0.84,0.91) | <0.001 | 0.97 (0.93,1.01) | 0.176 |
| 2013 | 108,539 | 3,696 (3.41) | 1.09 (1.05,1.13) | <0.001 | 1.27 (1.22,1.32) | <0.001 |
| 2014 | 83,549 | 3,088 (3.70) | 1.18 (1.14,1.23) | <0.001 | 1.31 (1.25,1.37) | <0.001 |
| 2015 | 64,674 | 2,455 (3.80) | 1.21 (1.16,1.26) | <0.001 | 1.25 (1.19,1.32) | <0.001 |
| 2016 | 43,212 | 1,664 (3.85) | 1.23 (1.17,1.29) | <0.001 | 1.36 (1.28,1.44) | <0.001 |
| 2017 | 33,218 | 1,388 (4.18) | 1.33 (1.26,1.41) | <0.001 | 1.25 (1.17,1.34) | <0.001 |
| 2018 | 12,774 | 514 (4.02) | 1.28 (1.18,1.40) | <0.001 | 1.34 (1.21,1.49) | <0.001 |
| BMI category (kg/m 2 ) at diagnosis with overweight/obesity | ||||||
| 23.0–24.9 (B&A only) | 29,158 | 178 (0.61) | 0.45 (0.39,0.52) | <0.001 | 0.36 (0.30,0.43) | <0.001 |
| 25.0–29.9 | 1,006,478 | 13,529 (1.34) | 1.0 | 1.0 | ||
| 30.0–34.9 | 444,510 | 17,240 (3.88) | 2.89 (2.82,2.95) | <0.001 | 2.83 (2.75,2.90) | <0.001 |
| 35.0–40.0 | 162,595 | 10,025 (6.17) | 4.59 (4.47,4.70) | <0.001 | 4.20 (4.07,4.33) | <0.001 |
| 40.0 + | 83,901 | 8,436 (10.05) | 7.48 (7.29,7.68) | <0.001 | 6.19 (5.99,6.40) | <0.001 |
| Medical codes | 24,743 | 3,862 (15.61) | 11.61 (11.23,12.01) | <0.001 | 8.88 (8.53,9.25) | <0.001 |
| Ethnic group | ||||||
| White | 1,322,847 | 42,347 (3.20) | 1.0 | 1.0 | ||
| Asian | 70,014 | 1,723 (2.46) | 0.77 (0.73,0.81) | <0.001 | 0.99 (0.93,1.05) | 0.726 |
| Black | 42,712 | 1,520 (3.56) | 1.11 (1.06,1.17) | <0.001 | 1.19 (1.12,1.26) | <0.001 |
| Mixed | 12,009 | 355 (2.96) | 0.92 (0.83,1.02) | 0.129 | 1.01 (0.89,1.14) | 0.926 |
| Other | 19,647 | 576 (2.93) | 0.92 (0.84,0.99) | 0.033 | 0.92 (0.84,1.02) | 0.101 |
| Unknown | 284,156 | 6,749 (2.38) | 0.74 (0.72,0.76) | <0.001 | 0.71 (0.68,0.74) | <0.001 |
| IMD | ||||||
| 1 (least deprived) | 290,170 | 7,017 (2.42) | 1.0 | 1.0 | ||
| 2 | 288,664 | 8,374 (2.90) | 1.20 (1.16,1.24) | <0.001 | 1.13 (1.09,1.16) | <0.001 |
| 3 | 279,202 | 7,219 (2.59) | 1.07 (1.04,1.10) | <0.001 | 0.99 (0.96,1.03) | 0.665 |
| 4 | 259,566 | 7,875 (3.03) | 1.25 (1.22,1.30) | <0.001 | 1.10 (1.06,1.13) | <0.001 |
| 5 (most deprived) | 235,220 | 8,696 (3.70) | 1.53 (1.48,1.58) | <0.001 | 1.16 (1.13,1.20) | <0.001 |
| Data missing/not recorded | 398,563 | 14,089 (3.53) | - | - | ||
| Smoking status | ||||||
| Nonsmoker | 802,920 | 26,526 (3.30) | 1.0 | 1.0 | ||
| Current smoker | 330,257 | 11,084 (3.36) | 1.02 (0.99,1.04) | 0.156 | 0.93 (0.91,0.95) | <0.001 |
| Ex-smoker | 453,803 | 13,763 (3.03) | 0.92 (0.90,0.94) | <0.001 | 1.00 (0.97,1.02) | 0.798 |
| Data missing/not recorded | 164,405 | 1,897 (1.15) | - | |||
| Presence of comorbidities f | ||||||
| Type 2 diabetes | 262,713 | 8,951 (3.41) | 1.14 (1.12,1.17) | <0.001 | 0.92 (0.90,0.95) | <0.001 |
| Hypertension | 483,016 | 12,870 (2.66) | 0.84 (0.82,0.85) | <0.001 | 0.78 (0.76,0.80) | <0.001 |
| Coronary heart disease | 219,434 | 4,426 (2.02) | 0.63 (0.61,0.65) | <0.001 | 0.83 (0.80,0.86) | <0.001 |
| Obstructive sleep apnoea | 27,969 | 2,305 (8.24) | 2.79 (2.68,2.90) | <0.001 | 1.63 (1.55,1.70) | <0.001 |
| Asthma | 271,421 | 9,759 (3.60) | 1.22 (1.20,1.25) | <0.001 | 1.01 (0.98,1.03) | 0.623 |
| Chronic musculoskeletal condition | 381,461 | 13,248 (3.47) | 1.19 (1.17,1.21) | <0.001 | 1.21 (1.18,1.24) | <0.001 |
| Gastro-oesophageal reflux disease | 485,268 | 17,286 (3.56) | 1.25 (1.23,1.28) | <0.001 | 1.14 (1.11,1.16) | <0.001 |
| Liver disease | 37,430 | 1,325 (3.54) | 1.17 (1.11,1.23) | <0.001 | 1.02 (0.97,1.08) | 0.435 |
| Polycystic ovarian syndrome | 25,879 | 1,598 (6.17) | 2.06 (1.96,2.16) | <0.001 | 1.29 (1.22,1.37) | <0.001 |
| Fertility problems | 41,151 | 1,763 (4.28) | 1.42 (1.36,1.49) | <0.001 | 1.11 (1.06,1.18) | <0.001 |
| Depression | 456,930 | 19,164 (4.19) | 1.59 (1.56,1.62) | <0.001 | 1.17 (1.14,1.19) | <0.001 |
| Anxiety | 337,680 | 13,148 (3.89) | 1.37 (1.35,1.40) | <0.001 | 1.07 (1.05,1.10) | <0.001 |
| Idiopathic intracranial hypertension | 1,635 | 146 (8.93) | 2.94 (2.52,3.43) | <0.001 | 1.31 (1.11,1.56) | 0.002 |
Text in italics indicates the reference group for the Poisson regression model.
B&A, Black and Asian ethnic groups; BMI, body mass index; CI, confidence interval; CPRD, Clinical Practice Research Datalink; GP, general practitioner; IMD, Index of Multiple Deprivation; NHS, National Health Service; RR, rate ratio; T2DM, type 2 diabetes mellitus; WM, weight management.
aPatients without “research quality” data excluded (N = 18,935).
bVariables included in adjusted model include sex, age group at diagnosis with overweight/obesity, Strategic Health Authority of GP practice, rural–urban classification of GP practice, year of diagnosis with overweight/obesity, BMI category at diagnosis with overweight/obesity, ethnic group, IMD, smoking status, presence of comorbidities (each of 13 comorbidities included individually in the model).
cNumber of individuals included in the crude analysis.
dNumber of individuals with complete data for all variables included in the adjusted analysis.
eIndeterminate and unknown sex excluded due to small numbers (n = 18).
fCompared with not having comorbidity.