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Are variations in the use of carotid endarterectomy explained by population need? A study of health service utilisation in two English health regions

Lookup NU author(s): Emeritus Professor Richard Thomson


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Objectives: to describe variation in utilisation of carotid endarterectomy (CEA) within two English health regions and explore relationships between use, need and proximity to services. Design: consecutive case series of operations. Comparison at a population level with district stroke mortality, hospital admissions and material deprivation. Main outcome measures: standardised utilisation rates for CEA and measures of inter-district variability. Spearman's rank correlation coefficients for associations between variables. Results: variation in utilisation rates was considerable (14-fold difference cross district populations). More individuals had bilateral surgery in the Yorkshire region than in the Northern (11.7% vs. 5.5%, p = 0.002). There was no associations between utilisation rates for CEA and district stroke mortality (r = -0.06, 95% CI -0.41 to 0.30) or admission rates for stroke (r = 0.17, 95% CI -0.2 to 0.49). There was a strong relationship between residence in districts where services were located and higher utilisation. Rates of CEA were lowest in the regions' most affluent wards. Conclusion: use of CEA varies widely, depending on area of residence. Variation is not a consequence of differences in need, but reflects clinical practice and supply of services. There is evidence to suggest unmet need for CEA.

Publication metadata

Author(s): Oliver SE, Thomson RG

Publication type: Article

Publication status: Published

Journal: European Journal of Vascular and Endovascular Surgery

Year: 1999

Volume: 17

Issue: 6

Pages: 501-506

Print publication date: 01/06/1999

ISSN (print): 1078-5884

ISSN (electronic): 1532-2165

Publisher: Elsevier Ltd


DOI: 10.1053/ejvs.1999.0792

PubMed id: 10375486


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