**********S6 Appendix: Adjusted rate ratios for provision of bariatric surgery within adults eligible for bariatric surgery and HES linkage in England with at least five years of follow-up data in CPRD GOLD (2007-2020)********** **********People with unknown ethnicity dropped (n=17,844)********** ***MODEL A (with individual co-morbidities)*** poisson outc_bs ib2.gender ib3.age_index_complex_cat ib2.region ib1.e2011_urban_rural ib6.ethnicity ib1.imd2015_5 ib3.smoking_category i.index_complex_year ib3.index_complex_ > bmi_cat i.comorb1 i.comorb2 i.comorb3 i.comorb4 i.comorb5 i.comorb6 i.comorb7 i.comorb8 i.comorb9 i.comorb10 i.comorb11 i.comorb12 i.comorb13, irr vce(robust) Iteration 0: log pseudolikelihood = -15843.595 Iteration 1: log pseudolikelihood = -13353.409 Iteration 2: log pseudolikelihood = -13268.114 Iteration 3: log pseudolikelihood = -13266.109 Iteration 4: log pseudolikelihood = -13266.087 Iteration 5: log pseudolikelihood = -13266.087 Poisson regression Number of obs = 263,950 Wald chi2(52) = 7714.71 Prob > chi2 = 0.0000 Log pseudolikelihood = -13266.087 Pseudo R2 = 0.2497 ----------------------------------------------------------------------------------------------------- | Robust outc_bs | IRR std. err. z P>|z| [95% conf. interval] ------------------------------------+---------------------------------------------------------------- gender | Male | .7670228 .0337065 -6.04 0.000 .7037244 .8360148 | age_index_complex_cat | 18-24 | 1.284095 .1026561 3.13 0.002 1.097863 1.501917 25-34 | 1.456241 .0827226 6.62 0.000 1.302808 1.627745 35-44 | 1.360452 .0614775 6.81 0.000 1.24514 1.486443 55-64 | .3708926 .0230298 -15.97 0.000 .3283935 .4188916 65-74 | .0730981 .0113546 -16.84 0.000 .0539121 .099112 75+ | .0040672 .0040726 -5.50 0.000 .0005714 .0289483 | region | North East | 3.048211 .2738116 12.41 0.000 2.556137 3.635012 Yorkshire & The Humber | 1.954843 .1824461 7.18 0.000 1.628055 2.347226 East Midlands | 1.372319 .161548 2.69 0.007 1.089564 1.728454 West Midlands | 1.456179 .1075551 5.09 0.000 1.259923 1.683005 East of England | 1.266144 .1057918 2.82 0.005 1.074884 1.491436 South West | 1.731409 .1223383 7.77 0.000 1.507493 1.988584 South Central | 1.669488 .1219534 7.02 0.000 1.446787 1.92647 London | 3.259021 .2224222 17.31 0.000 2.85098 3.725461 South East Coast | 2.16036 .1493804 11.14 0.000 1.886553 2.473907 | e2011_urban_rural | Rural | 1.013094 .0562276 0.23 0.815 .9086719 1.129515 | ethnicity | Asian | .9450723 .1063182 -0.50 0.616 .7580661 1.178211 Black | .9009523 .0890106 -1.06 0.291 .742346 1.093446 Mixed | 1.462363 .237873 2.34 0.019 1.063153 2.011475 Other | 1.239638 .1693168 1.57 0.116 .9484899 1.620156 | imd2015_5 | 2 | 1.075147 .0689416 1.13 0.258 .9481704 1.219128 3 | 1.110232 .068389 1.70 0.090 .9839675 1.252699 4 | 1.027772 .0630807 0.45 0.655 .911283 1.159151 5 | 1.023415 .0637898 0.37 0.710 .9057247 1.156399 | smoking_category | current | .8706213 .0382347 -3.15 0.002 .7988173 .9488797 ex-smoker | 1.217792 .0491597 4.88 0.000 1.125154 1.318058 | index_complex_year | 2008 | .8712631 .0400138 -3.00 0.003 .7962636 .9533267 2009 | .696172 .04111 -6.13 0.000 .6200858 .7815942 2010 | .5896933 .0414653 -7.51 0.000 .5137745 .6768304 2011 | .5744478 .0431973 -7.37 0.000 .4957262 .6656703 2012 | .5028733 .0431246 -8.02 0.000 .4250722 .5949144 2013 | .4029815 .0405143 -9.04 0.000 .3309088 .4907516 2014 | .3885401 .0445385 -8.25 0.000 .3103575 .4864179 2015 | .1861998 .0502736 -6.23 0.000 .1096873 .3160837 | index_complex_bmi_cat | 27.5-29.9 in BAME + T2DM ≥10 years | .0873261 .0332989 -6.39 0.000 .0413587 .1843831 30.0-34.9 + T2DM ≥10 years | .2885825 .046152 -7.77 0.000 .210931 .3948204 40.0 + | 5.542883 .2435636 38.97 0.000 5.085487 6.041419 READ codes | 10.07476 4.530228 5.14 0.000 4.173329 24.32131 | comorb1 | Y | .9559933 .036314 -1.18 0.236 .8874041 1.029884 | comorb2 | Y | 1.127888 .0419465 3.24 0.001 1.0486 1.213173 | comorb3 | Y | .8098975 .0491145 -3.48 0.001 .7191356 .9121146 | comorb4 | Y | 1.693466 .0646637 13.80 0.000 1.571354 1.825068 | comorb5 | Y | 1.136225 .0827712 1.75 0.080 .9850459 1.310607 | comorb6 | Y | 1.355593 .0482965 8.54 0.000 1.264163 1.453635 | comorb7 | Y | .9802102 .0385292 -0.51 0.611 .9075299 1.058711 | comorb8 | Y | 1.446411 .2211789 2.41 0.016 1.071839 1.951883 | comorb9 | Y | 2.183943 .1194966 14.28 0.000 1.961855 2.431171 | comorb10 | Y | 1.71 .0704017 13.03 0.000 1.577436 1.853705 | comorb11 | Y | 2.584409 .1236896 19.84 0.000 2.353004 2.83857 | comorb12 | Y | 1.762757 .1015816 9.84 0.000 1.574493 1.973533 | comorb13 | Y | 1.188697 .0486061 4.23 0.000 1.097148 1.287884 _cons | .0028827 .0002803 -60.15 0.000 .0023825 .003488 ----------------------------------------------------------------------------------------------------- Note: _cons estimates baseline incidence rate. Comorb 1=Anxiety, comorb2=Asthma, comorb3=Coronary Heart Disease, comorb4=Depression, comorb5=Fertility problems, comorb6=Gastro-oesophageal reflux, comorb7=Hypertension, comorb8=Idiopathic Intracranial Hypertension, comorb9=Liver disease, comorb10=Chronic musculoskeletal pain, comorb11=Obstructive sleep apnoea, comorb12=Polycystic ovarian syndrome, comorb13=Type 2 diabetes ***MODEL B - with total number of comorbidities*** poisson outc_bs ib2.gender ib3.age_index_complex_cat ib2.region ib1.e2011_urban_rural ib6.ethnicity ib1.imd2015_5 ib3.smoking_category i.index_complex_year ib3.index_complex_ > bmi_cat i.comorb_total, irr vce(robust) Iteration 0: log pseudolikelihood = -14030.997 Iteration 1: log pseudolikelihood = -13512.098 Iteration 2: log pseudolikelihood = -13494.027 Iteration 3: log pseudolikelihood = -13492.945 Iteration 4: log pseudolikelihood = -13492.881 Iteration 5: log pseudolikelihood = -13492.88 Poisson regression Number of obs = 263,950 Wald chi2(45) = 6208.32 Prob > chi2 = 0.0000 Log pseudolikelihood = -13492.88 Pseudo R2 = 0.2369 ----------------------------------------------------------------------------------------------------- | Robust outc_bs | IRR std. err. z P>|z| [95% conf. interval] ------------------------------------+---------------------------------------------------------------- gender | Male | .7737631 .0320134 -6.20 0.000 .7134946 .8391225 | age_index_complex_cat | 18-24 | 1.449509 .1101313 4.89 0.000 1.248959 1.682263 25-34 | 1.618015 .0833371 9.34 0.000 1.462651 1.789881 35-44 | 1.437318 .061808 8.44 0.000 1.321141 1.563711 55-64 | .3495 .0213859 -17.18 0.000 .3100004 .3940325 65-74 | .0629802 .009675 -18.00 0.000 .046606 .0851071 75+ | .0032425 .0032446 -5.73 0.000 .0004562 .0230478 | region | North East | 3.046333 .271991 12.48 0.000 2.557279 3.628914 Yorkshire & The Humber | 1.9195 .1789143 7.00 0.000 1.599 2.304239 East Midlands | 1.345922 .1586945 2.52 0.012 1.06821 1.695833 West Midlands | 1.489245 .1101981 5.38 0.000 1.288192 1.721677 East of England | 1.318466 .1102956 3.30 0.001 1.119082 1.553373 South West | 1.761446 .1244389 8.01 0.000 1.533682 2.023034 South Central | 1.729329 .1263662 7.50 0.000 1.498574 1.995616 London | 3.513635 .2387033 18.50 0.000 3.075596 4.014063 South East Coast | 2.269882 .156236 11.91 0.000 1.983422 2.597715 | e2011_urban_rural | Rural | 1.00106 .0557617 0.02 0.985 .8975231 1.11654 | ethnicity | Asian | .9186428 .1036683 -0.75 0.452 .7363582 1.146052 Black | .8660469 .085807 -1.45 0.147 .71319 1.051665 Mixed | 1.402731 .2320706 2.05 0.041 1.014262 1.939987 Other | 1.250269 .1701089 1.64 0.101 .9576148 1.632361 | imd2015_5 | 2 | 1.079196 .0692684 1.19 0.235 .9516248 1.223869 3 | 1.109493 .068438 1.68 0.092 .9831482 1.252074 4 | 1.037262 .0635235 0.60 0.550 .9199406 1.169546 5 | 1.016382 .0631568 0.26 0.794 .8998384 1.148021 | smoking_category | current | .8739579 .0382807 -3.08 0.002 .8020594 .9523016 ex-smoker | 1.224311 .0493947 5.02 0.000 1.131228 1.325054 | index_complex_year | 2008 | .8943304 .0412524 -2.42 0.015 .8170243 .9789511 2009 | .7241062 .0427411 -5.47 0.000 .6449993 .8129152 2010 | .61529 .0433439 -6.89 0.000 .5359413 .7063867 2011 | .6045001 .0454572 -6.69 0.000 .5216602 .7004951 2012 | .5289724 .0453999 -7.42 0.000 .4470719 .6258766 2013 | .4311701 .0431919 -8.40 0.000 .3543078 .5247067 2014 | .4175363 .0481571 -7.57 0.000 .333058 .5234421 2015 | .1980998 .0537574 -5.97 0.000 .1163851 .3371868 | index_complex_bmi_cat | 27.5-29.9 in BAME + T2DM ≥10 years | .0758759 .0288813 -6.77 0.000 .0359835 .1599942 30.0-34.9 + T2DM ≥10 years | .2567064 .0406224 -8.59 0.000 .1882517 .3500537 40.0 + | 6.060821 .2668575 40.92 0.000 5.559723 6.607084 READ codes | 10.81283 4.861038 5.30 0.000 4.479933 26.098 | comorb_total | 1 | 1.880394 .1934943 6.14 0.000 1.536949 2.300585 2 | 2.793671 .2792592 10.28 0.000 2.296614 3.398307 3 | 3.92285 .3909047 13.72 0.000 3.226867 4.768946 4 | 5.768155 .5780199 17.49 0.000 4.739571 7.019962 5 | 7.311262 .7587612 19.17 0.000 5.96561 8.960451 6+ | 8.738714 .9237813 20.51 0.000 7.103393 10.75051 | _cons | .0015616 .0002064 -48.89 0.000 .0012052 .0020233 ----------------------------------------------------------------------------------------------------- Note: _cons estimates baseline incidence rate.