Geographic variation in the rate of carotid endarterectomy in Canada

Background and Purpose-Carotid endarterectomy (CEA) is an important method of stroke prevention, but its usage in Canada is not well known. The indica tions for CEA have been well informed by the recent clinical trials, but th e impact of this information on the rate and regional variation in the rate of CEA is unknown. This study sought to determine the rate and the regiona l variation in the rate of CEA in Canada, its provinces, and census divisio ns for 1994-1997. Methods-Discharge data from all hospitals in Canada except Quebec were obta ined from the Canadian Institute for Health Information for 1994-1997 and w ere searched for CEA by residential site. Rates and variations in rates wer e calculated. Results-The national age- and sex-adjusted rate per 100 000 people of CEA f or those aged greater than or equal to 40 years rose from 31.7 in 1994 to 4 0.5 in 1997. Provincial rates in 1997 varied from a low of 25.7 in Saskatch ewan to high of 82.8 in Prince Edward Island. The census division rates var ied even more, from a low of 0 in several divisions to a high of 179. Conclusions-The recent slight increase in CEA rates may reflect the release of new efficacy results for CEA, especially for asymptomatic carotid steno sis, but the rates are still far below US levels. The marked regional varia tion in rates may reflect differing views on the appropriateness of indicat ions such as asymptomatic carotid stenosis for CEA and the inconsistency of published clinical practice guidelines.