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  1. Coronary revascularisation : why do rates vary geographically in the UK ?

    Article - En anglais

    Objective

    To explain the reasons for geographical variation in the use of coronary revascularisation in the United Kingdom.

    Design

    This was a cross sectional ecological study.

    Setting

    NHS and independent hospitals performing coronary revascularisation for the 11.6 million residents of the south east Thames, East Anglian and north western health regions in England plus Greater Glasgow, Lanarkshire, Ayr and Arran health boards in Scotland were included.

    Subjects

    All residents aged =25 years in 1992-93 who underwent coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) in either the public or private sector were included.

    Main measures

    Crude and age-sex standardised intervention rates for residents of the 42 constituent districts and boards were determined.

    Variation was measured using the systematic component of variation.

    Results

    Considerable systematic variations in district rates of CABG and PTCA existed.

    These variations mostly arose from differences in supply factors.

    Conclusions

    If greater geographical equity of use for the same level of need is to be achieved, attention must be paid to the supply factors that determine levels of utilisation.

    As responsibility for purchasing these procedures is decentralised, utilisation might become even more unequal.

    Mots-clés Pascal : Circulation extracorporelle, Dérivation, Artère coronaire, Dilatation instrumentale, Technique, Utilisation, Epidémiologie, Variation géographique, Royaume Uni, Europe, Homme, Chirurgie, Traitement instrumental

    Mots-clés Pascal anglais : Cardiopulmonary bypass, Bypass, Coronary artery, Instrumental dilatation, Technique, Use, Epidemiology, Geographical variation, United Kingdom, Europe, Human, Surgery, Instrumentation therapy

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 95-0482167

    Code Inist : 002B26E. Création : 01/03/1996.