Disparities in access to bariatric surgery among adolescents: A population based study in Brazil

• Bariatric surgery access is unequal among Brazilian adolescents. • White adolescents are more likely to receive surgery than non-white peers. • Most surgeries are performed in southern regions of Brazil with higher Human Development Index (IHD). • Adolescents travel long distances for high-complexity obesity treatment. • Despite disparities in access, post-surgical outcomes are similar across groups. Adolescent obesity is a growing public health crisis in Brazil, a country whose Unified Health System’s (SUS) has a stated commitment to equity. This study examines whether access to specialized surgical care, such as bariatric surgery, is equitable among Brazilian adolescents. We conducted a retrospective study of a national medical database: DATASUS, from 2012 to 2023, comparing patients aged 12–17 who underwent bariatric surgery with non-hospitalized obese adolescents. Variables analyzed included age, gender, White race, distance to the treatment center, and region of residence. Univariate and multivariate logistic regression models were used to evaluate predictors of access to bariatric surgery and postoperative outcomes. 224 adolescents underwent bariatric surgery compared to 490,063 nonhospitalized obese adolescents. White patients were over 3 times more likely to receive surgery than non-white patients (OR: 3.91, p<0.001). Regions with higher Human Development Indices (HDI) (South and Southeast) performed the highest proportion of surgeries (54.5% and 40.2% respectively), while the lower HDI regions (North and Northeast), accounted for less than 5% of bariatric surgeries performed. Adolescents undergoing surgery traveled farther for treatment (240.0 ± 170.3 km) than non-hospitalized patients (3.23 ± 4.63 km, p<0.001). Postoperative outcomes, including ICU need and cost of care, were comparable between racial groups. Unequal access to bariatric surgery for adolescents exists in Brazil. White patients in higher HDI areas are more likely to access surgery compared to non-white and lower HDI counterparts. The findings underscore the need for policies to improve equitable access to specialized surgical care.