The relationship between socio-economic status, geography, symptomatic carotid territory disease and carotid endarterectomy.

OBJECTIVE

recent evidence suggests a strong association between socio-economic status and atherosclerosis. However, little information exists on the relationship between socio-economic status, symptomatic carotid disease and rates of carotid endarterectomy (CEA). The aim was to evaluate the Carstair Deprivation Score (CDS) of (1) patients admitted with symptomatic carotid disease, and (2) those undergoing CEA in one health board.

METHOD

the CDS score was determined from the post-codes of all patients admitted with a diagnosis of transient ischaemic attack (TIA) or stroke due to cerebral infarction (ISD 9 codes 433.1, 433.09, 435, 437.1; ICD-10: 165.2, 163, 163.2, G45.1, G45.3, G45.9) between 1st April 1995 and 31st March 2000. Expected and actual rates for each of the CDS (1 to 7) were determined by direct and indirect methods of standardisation allowing for age and sex. A similar analysis was performed for patients undergoing carotid endarterectomy. Results were analysed using the Mantel-Haenszel test. Only first time admissions and CEA were included.

RESULTS

1203 patients were admitted with the main diagnosis of symptomatic carotid disease. The admission rate of symptomatic patients was less than expected in the more affluent group (Carstair 1, p < 0.005) and significantly higher in the most deprived group (Carstair 7, p < 0.001). In comparison 192 patients underwent CEA. There were no differences between the expected and actual rates of CEA in each CDS, but the rates tended to be higher in the most affluent group. Geographical variation was also demonstrated with an increased rate of CEA in those patients living in the cities and a reduced rate in those in the rural communities.

CONCLUSION

patients from deprived socio-economic groups had a higher rate of symptomatic carotid disease, but this was not matched by an increased rate of CEA. This suggests that socio-economic inequalities in the prevalence of symptomatic carotid artery disease and treatment exist.