Relationship between the regional and national incidence of transient ischaemic attack and stroke and performance of carotid endarterectomy

Abstract

Objectives: To examine the relationship between the incidence of transient ischaemic attack (TIA) and stroke on a national and regional level and the rate of carotid endarterectomy (CEA).

Subjects: Patients entered onto a national primary care computerised database with a new diagnostic code of stroke or TIA between 1992 and 1995.

Methods: Analysis of data from the primary care database and routine data sources. Main outcome measures were incidence of TIA and stroke and rates of CEA.

Results: The mean incidence per 100,000 of the population was 292 (TIA) and 356 (stroke) in England, 391 and 497 in Scotland and 349 and 448 in Northern Ireland. There was a variation in the incidence of TIA and stroke between both the regions and the regions and countries which was significant. There was a national increase in the rate of CEA between 1990 and 1995 which showed a marked variation across the regions. The inter-regional variation in rate of CEA correlated with the inter-regional difference in incidence of disease.

Conclusions: The incidence of TIA and stroke may be higher than previously recognised, and varies significantly between the regions. This is generally associated with the variation in performance of CEA.