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

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 cave computerised database with a new diagnostic code of stroke or TIA between 1992 and 1995. Methods: Analysis of data from the primary cave 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 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.