Geographical inequality in the provision of carotid endarterectomy in Scotland. Scottish Vascular Audit Group

BACKGROUND: Carotid endarterectomy (CEA) is a proven method of stroke prevention in patients with symptomatic and asymptomatic high-grade internal carotid artery stenosis. This study examined whether site of residence affects access to CEA in Scotland. METHODS: Scottish Morbidity Record hospital discharge data were collected by the Information and Statistics Division of the National Health Service in Scotland and analysed for the interval 1 January 1989 to 31 December 1995. The number of CEAs performed in the hospitals of each of the 15 regional Health Boards, and CEA rate per 100000 population resident in each Health Board region, were determined. RESULTS: In 1989, 65 CEAs were performed in the hospitals of five Health Boards and in 1995, 431 CEAs were performed in nine Health Boards. In 1989, the CEA rate per 100000 resident population varied between 0 (four regions) and 4 (one region), with one region significantly different from Scotland as a whole (P<0.001). In 1995, the CEA rate varied between 0 (two regions) and 19 (one region), with two regions significantly different from Scotland as a whole (P< 0.01). CONCLUSION: Despite a sixfold increase in the number of CEAs being performed, and a rise in the number of centres performing CEA, there is increasing geographical inequality in the provision of CEA in Scotland.