Age diffusion never stops? Carotid endarterectomy among the elderly

In view of the rising proportion of elderly in the population, diffusion of medical technologies to the elderly is a particularly interesting phenomenon, with respect to both quality of life and health care costs. Using data on all carotid endarterectomies (CEAs) performed in Sweden, we explore the pattern of age diffusion 1982-1999. The overall rates of CEA are considerably lower in Sweden than in the US and Canada, possibly reflecting the different reimbursement systems. At the same time, the responses from the health-care sectors in the three countries to the scientific literature seem to have been qualitatively very similar. Prominent age diffusion - a relative shift of procedure rates towards elderly patients - is demonstrated for the whole period, both when overall treatment rates are increasing, when they are declining, and when they remain relatively constant. Furthermore, in Sweden (contrary to what was the case North America) there was not just a relative shift, but treatment rates actually increased among the 75+ when overall rates were declining, perhaps indicating a previous resource constraint on extending treatment to this age group. There are differences in levels of treatment rates between men and women but the pattern of age diffusion appears strikingly gender-neutral.