Regional Variation in the Use of Percutaneous Coronary Intervention in Japan.

BACKGROUND

Regional variations in health-care delivery, processes and spending have been reported across the world. Differences in revascularization procedures have been observed in the USA and Canada, but little is known about regional variation in revascularization procedures in Japan.

METHODS AND

RESULTS

Diagnostic procedure combination summary tables for 2013 issued by the Japanese government were used. The rates of percutaneous coronary intervention (PCI) per 100,000 population aged ≥40 years in each prefecture were summarized by angina and myocardial infarction (MI). Linear regression analysis was performed to investigate the factors associated with regional variation in the rate of PCI for angina. The mean PCI rates were 189 and 67 per 100,000 population for angina and MI, respectively. The ratios between the highest and lowest regions were 4.9-fold in angina and 1.8-fold in MI. The factor most associated with generating regional variation in the use of PCI for angina was the rate of coronary angiography (CAG; P<0.001).

CONCLUSIONS

Wide regional variation was observed in the use of PCI both for angina and for MI. The variation was larger for angina, in which PCI were mostly elective and positively associated with the use of CAG. Further research is needed to prevent overuse and underuse of PCI to ensure more appropriate health-care delivery and to control health-care expenditure.