Comparing the Use of Diagnostic Imaging and Receipt of Carotid Endarterectomy in Elderly Black and White Stroke Patients

• Published in: Journal of stroke and cerebrovascular diseases Vol. 21; no. 7; pp. 600 - 606
• Main Authors: Martin, Kimberly D., PhD, Naert, Lisa, BS, Goldstein, Larry B., MD, Kasl, Stanislav, PhD, Molinaro, Annette M., PhD, Lichtman, Judith H., PhD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2012
• Subjects: African Americans - statistics & numerical data; Age Factors; Aged; Aged, 80 and over; Cardiovascular; Carotid endarterectomy; carotid stenosis; Carotid Stenosis - diagnosis; Carotid Stenosis - ethnology; Carotid Stenosis - surgery; Chi-Square Distribution; diagnostic imaging; Diagnostic Imaging - utilization; Endarterectomy, Carotid - utilization; European Continental Ancestry Group - statistics & numerical data; Fee-for-Service Plans - statistics & numerical data; Female; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - ethnology; Humans; Logistic Models; Magnetic Resonance Angiography - utilization; Male; Medicare - statistics & numerical data; Multivariate Analysis; Neurology; Odds Ratio; Patient Selection; Predictive Value of Tests; racial differences; Severity of Illness Index; Stroke - diagnosis; Stroke - ethnology; Stroke - surgery; Ultrasonography, Doppler, Duplex - utilization; United States; United States; Carotid endarterectomy; carotid stenosis; diagnostic imaging; racial differences
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2011.02.002

Background Previous studies show that black patients undergo carotid endarterectomy (CEA) less frequently than white patients. Diagnostic imaging is necessary to determine whether a patient is a candidate for the operation. We determined whether there were differences in the use of diagnostic carotid imaging and the frequency of CEA between elderly black and white ischemic stroke patients. Methods Medicare fee-for-service beneficiaries with discharge diagnoses of ischemic stroke ( International Classification of Diseases , 9th revision codes 433, 434, and 436) were randomly selected for inclusion in the National Stroke Project 1998-1999, 2000-2001. Receipt of at least one type of carotid imaging study was compared for black and white patients. Binomial logistic regression models were used to evaluate the associations between race and receipt of carotid imaging and CEA with adjustment for demographics, degree of carotid artery stenosis, and other clinical covariates. Results Among 19,639 stroke patients (1974 black, 17,655 white), 69.6% received at least 1 diagnostic carotid imaging test (blacks 68.4%; whites 69.7%; P = .233). After risk adjustment, blacks were less likely to receive carotid imaging (adjusted odds ratio [OR] 0.87; 95% confidence interval [CI] 0.78-0.97). There was no relationship between race and the receipt of CEA after adjustment for degree of carotid stenosis and other covariates (adjusted OR 1.14; 95% CI 0.66-1.96). Conclusions Black ischemic stroke patients were less likely to receive diagnostic carotid imaging than white patients, although the difference was small and only significant after risk adjustment. There was no difference in the proportion having CEA after adjustment for degree of carotid artery stenosis and other clinical factors.