Adam D J, Bain M, Shanks E, Bradbury A W
University Department of Surgery, Royal Infirmary, Edinburgh, UK.
Br J Surg. 1998 Aug;85(8):1075-9. doi: 10.1046/j.1365-2168.1998.00753.x.
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.
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.
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).
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.
颈动脉内膜切除术（CEA）是一种已被证实的预防有症状和无症状的重度颈内动脉狭窄患者中风的方法。本研究调查了居住地点是否会影响苏格兰患者接受CEA的机会。
收集了苏格兰国民医疗服务体系信息与统计部的苏格兰发病率记录医院出院数据，并对1989年1月1日至1995年12月31日期间的数据进行了分析。确定了15个地区卫生委员会中每个委员会的医院所进行的CEA手术数量，以及每个卫生委员会区域每10万居民的CEA手术率。
1989年，五个卫生委员会的医院共进行了65例CEA手术；1995年，九个卫生委员会进行了431例CEA手术。1989年，每10万常住人口的CEA手术率在0（四个地区）至4（一个地区）之间，其中一个地区与整个苏格兰有显著差异（P<0.001）。1995年，CEA手术率在0（两个地区）至19（一个地区）之间，其中两个地区与整个苏格兰有显著差异（P<0.01）。
尽管CEA手术数量增加了六倍，且进行CEA手术的中心数量有所上升，但在苏格兰，CEA手术的提供在地理上的不平等现象却日益加剧。
