This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Evans, A. Articles by Matchar, D. Search for Related Content PubMed Articles by Evans, A. Articles by Matchar, D.

(Stroke. 1999;30:2491-2492.)
© 1999 American Heart Association, Inc.

Letters to the Editor

Racial Inequity of Access to Carotid Imaging

Andy Evans, BSc, MRCP Lallit Kalra, MD, PhD

Department of Stroke Medicine, Guy's, King's & St Thomas' School of Medicine, London, England

	Introduction

 
To the Editor:

While we welcome research into stroke in patients of African and Caribbean origin, we have a number of concerns regarding the conclusions of Oddone et al on racial differences in the use of carotid imaging.¹

Lacunar stroke may give a presentation identical to that of a transient ischemic attack (TIA). There is a high prevalence of lacunar stroke in people of Afro-Caribbean heritage both in the United States and the United Kingdom. Furthermore, there is a negative correlation between lacunar stroke and carotid disease.² Thus, when the strictest indication for carotid imaging is used (to define a symptomatic stenosis in a patient suitable for surgery), a higher proportion of African-American patients may not have qualified. (The brain imaging was not reviewed in the study.)

Of the African-Americans in the TIA group, 34.9% (30 of 86) had had a previous TIA and 33.7% (29 of 86) a previous stroke, compared with 15.2% (28 of 184) and 16.3% (30 of 184) of white patients. As the study only analyzed photocopies of case records from the index admission and for 6 months afterwards, it is conceivable that some of these patients' carotids had been imaged previously. If a normal carotid study had been performed recently, repeat imaging might be considered an inappropriate use of resources. If this situation held for even 4 African-American patients, the statistical significance for the statement "fewer black than white patients with TIA...received...studies of their carotid arteries" is lost.

In terms of the lower proportion of . . . [Full Text of this Article]

Eugene Z. Oddone, MD; Ronnie Horner, PhD David Matchar, MD

Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, and Division of General Medicine, Duke University Medical Center, Durham, North Carolina

This article has been cited by other articles:

				J. P. Stansbury, H. Jia, L. S. Williams, W. B. Vogel, and P. W. Duncan Ethnic Disparities in Stroke: Epidemiology, Acute Care, and Postacute Outcomes Stroke, February 1, 2005; 36(2): 374 - 386. [Abstract] [Full Text] [PDF]