(Stroke. 1999;30:1350-1356.)
© 1999 American Heart Association, Inc.
Original Contributions |
Race, Presenting Signs and Symptoms, Use of Carotid Artery Imaging, and Appropriateness of Carotid Endarterectomy
From the Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC (E.Z.O., R.D.H., R.S., A.W., D.M.); Divisions of General Medicine (E.Z.O., R.D.H., D.M.) and Biometry (L.M.), Duke University Medical Center; Center for Clinical Health Policy Research, Duke University (E.Z.O., R.D.H., D.M.), Durham, NC; Pittsburgh Veterans Affairs Medical Center (Pa) (J.W.); Center for the Study of Healthcare Provider Behavior, West Los Angeles Veterans Affairs Medical Center (Calif) (L.J.P.); St Louis Veterans Affairs Medical Center (Mo) (L.K., R.H.); and Division of General Medicine, University of Minnesota Medical Center, Minneapolis (S.D.).
Background and Purpose—We sought to determine whether there are racial differences in use of carotid artery imaging after controlling for clinical factors and to ascertain racial differences in presenting signs and symptoms and overall appropriateness for carotid endarterectomy (CE).
Methods—We performed a retrospective cohort study of 803 patients older than 45 years, hospitalized between 1991 and 1994 at any of 4 Veterans Affairs Medical Centers, with a discharge diagnosis of transient ischemic attack or ischemic stroke. Clinical data were abstracted from the medical record, including presenting symptoms, diagnostic test results, and use of surgical procedures. Appropriateness for CE was determined according to RAND criteria.
Results—Black patients were more likely than white patients to present with stroke (78% versus 55%) but less likely to present with transient ischemic attack (22% versus 45%; P=0.001). There was no racial difference in medical comorbidity or preoperative risk. Black patients were less likely to have an imaging study of their carotid arteries (67% versus 79%; P=0.001). Race remained an independent predictor of imaging after adjustment for clinical factors (odds ratio=1.50; 95% CI, 1.06 to 2.13). Because of higher prevalence of significant carotid artery stenosis, whites were significantly more likely than blacks to be assessed as appropriate candidates for surgery with the use of RAND criteria (18% versus 4%; P=0.001).
Conclusions—Use of carotid artery imaging, a critical step in determining eligibility for CE, is influenced by the patient's race after controlling for clinical presentation. Adjustment for appropriateness of CE reduces but does not eliminate the importance of race.
Key Words: carotid endarterectomy • cerebrovascular disorders • racial differences
This article has been cited by other articles:
 |
|
 |
|
  C. M. Rousseau, G. N. Ioannou, J. A. Todd-Stenberg, K. L. Sloan, M. F. Larson, C. W. Forsberg, and J. A. Dominitz Racial Differences in the Evaluation and Treatment of Hepatitis C Among Veterans: A Retrospective Cohort Study Am J Public Health, May 1, 2008; 98(5): 846 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hravnak, J. Whittle, M. E. Kelley, S. Sereika, C. B. Good, S. A. Ibrahim, and J. Conigliaro Symptom Expression in Coronary Heart Disease and Revascularization Recommendations for Black and White Patients Am J Public Health, September 1, 2007; 97(9): 1701 - 1708. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. S. Jacobs, G. Birbeck, A. J. Mullard, S. Hickenbottom, R. Kothari, S. Roberts, and M. J. Reeves Quality of hospital care in African American and white patients with ischemic stroke and TIA Neurology, March 28, 2006; 66(6): 809 - 814. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Bravata, C. K. Wells, B. Gulanski, W. N. Kernan, L. M. Brass, J. Long, and J. Concato Racial Disparities in Stroke Risk Factors: The Impact of Socioeconomic Status Stroke, July 1, 2005; 36(7): 1507 - 1511. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 T. S. Maldonado, R. Moreno, P. J. Gagne, M. A. Adelman, M. M. Nalbandian, D. Bajakian, G. R. Jacobowitz, P. J. Lamparello, T. S. Riles, and C. B. Rockman Successful Management of Carotid Stenosis in a High-Risk Population at an Inner-City Hospital Vascular and Endovascular Surgery, November 1, 2004; 38(6): 511 - 517. [Abstract] [PDF]
|
|
|
|
 |
|
 R. C. Pasternak, M. H. Criqui, E. J. Benjamin, F. G. R. Fowkes, E. M. Isselbacher, P. A. McCullough, P. A. Wolf, and Z.-J. Zheng Atherosclerotic Vascular Disease Conference: Writing Group I: Epidemiology Circulation, June 1, 2004; 109(21): 2605 - 2612. [Full Text] [PDF]
|
|
|
|
|
|
S. Olindo, P. Cabre, R. Deschamps, C. Chatot-Henry, P. Rene-Corail, P. Fournerie, M. Saint-Vil, F. May, and D. Smadja Acute Stroke in the Very Elderly: Epidemiological Features, Stroke Subtypes, Management, and Outcome in Martinique, French West Indies Stroke, July 1, 2003; 34(7): 1593 - 1597. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. S. Babiarz, D. M. Yousem, B. A. Wasserman, C. Wu, W. Bilker, and N. J. Beauchamp Jr. Cavernous Carotid Artery Calcification and White Matter Ischemia AJNR Am. J. Neuroradiol., May 1, 2003; 24(5): 872 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, D. B. Matchar, J. Hoff-Lindquist, G. P. Samsa, R. D. Horner, and E. J. Kenton III Veterans Administration Acute Stroke (VASt) Study: Lack of Race/Ethnic-Based Differences in Utilization of Stroke-Related Procedures or Services * Diagnostic Disparities: Still Exist? Stroke, April 1, 2003; 34(4): 999 - 1004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Z. Oddone, R. D. Horner, D. C.C. Johnston, K. Stechuchak, L. McIntyre, A. Ward, L. G. Alley, J. Whittle, L. Kroupa, and J. Taylor Carotid Endarterectomy and Race: Do Clinical Indications and Patient Preferences Account for Differences? Stroke, December 1, 2002; 33(12): 2936 - 2943. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. D. Harada, V. M. Villa, and R. Andersen Satisfaction With VA and Non-VA Outpatient Care Among Veterans American Journal of Medical Quality, July 1, 2002; 17(4): 155 - 164. [Abstract] [PDF]
|
|
|
|
|
|
T. E. Feasby, H. Quan, W. A. Ghali, and J. M. Findlay Geographic Variation in the Rate of Carotid Endarterectomy in Canada Editorial Comment Stroke, October 1, 2001; 32(10): 2417 - 2422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Reed, S. C. Cramer, D. K. Blough, K. Meyer, J. G. Jarvik, and D. Z. Wang Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community Hospitals Editorial Comment Stroke, August 1, 2001; 32(8): 1832 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Brach and I. Fraserirector Can Cultural Competency Reduce Racial and Ethnic Health Disparities? a Review and Conceptual Model Med Care Res Rev, December 1, 2000; 57(4_suppl): 181 - 217. [Abstract] [PDF]
|
|
|
|
|
|
S. Chaturvedi, R. Aggarwal, and A. Murugappan Results of carotid endarterectomy with prospective neurologist follow-up Neurology, September 26, 2000; 55(6): 769 - 772. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Evans, L. Kalra, E. Z. Oddone, R. Horner, and D. Matchar Racial Inequity of Access to Carotid Imaging • Response Stroke, November 1, 1999; 30(11): 2491 - 2492. [Full Text] [PDF]
|
|