Although blacks have higher incidence and prevalence rates of stroke, this analysis of endarectectomy and cerebral arteriography use indicated that black patients discharged from nonfederal hospitals during the period from 1980 through 1993 were significantly less likely to undergo these procedures.

The estimated number of carotid endarterectomies (CE) “increased steadily from 1980 until 1985, reaching a peak of 107,000.” This pattern reversed through 1991; then a marked increase took place again in 1992 but did not continue into 1993. Rates for cerebral arteriography followed a similar trend.

Racial disparities persisted throughout the period of study. “At the beginning and end of the period, rates were over four times higher in whites than in blacks. In the mid-1980s, rates were seven times higher in whites than blacks. Whites also had higher rates of cerebral arteriography, but the disparity was not as great as for endarterectomy. Rates in whites were over 50% higher than those in blacks before 1988 and 20% higher in 1988 through 1992.” The authors note that these results may have been affected by data incompleteness, specifically the substantial number of discharges for which race was not indicated. Based on an unpublished study, they state that these missing data may have led to a “possible slight underestimate of the number and rates of procedures in whites.” Thus, “ racial disparity in procedures may be, if anything, even greater than that shown.”

As a possible explanation for the observed racial differences in rates of procedure, the authors cite several studies that indicate that blacks may have a greater prevalence of non-surgically treatable intracranial small vessel disease than whites. However, given the higher incidence rate of stroke among blacks, “it remains to be determined how much greater the absolute prevalence of carotid stenosis in the population is in whites than blacks.” Population-based data indicate that “carotid stenosis was 40% more prevalent in white than black men and twice as prevalent in white than in black women.” Though the differences did not attain statistical significance, “the excess was much less than the four to seven times white excess in CE rates.”