Stroke
1999 Jul;30(7):1350-6
Comment in:
Stroke. 1999 Nov;30(11):2491.
Race, presenting signs and symptoms, use of carotid artery imaging,
and appropriateness of carotid endarterectomy.
Oddone EZ, Horner RD, Sloane R, McIntyre L, Ward A, Whittle J, Passman LJ,
Kroupa L, Heaney R, Diem S, Matchar D.
Center for Health Services Research in Primary Care, Veterans Affairs
Medical Center, Durham, NC, USA. oddonOO1@mc.duke.edu
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.
PMID: 10390306 [PubMed - indexed for MEDLINE]
Stroke 1999 Nov;30(11):2491
Comment on:
Stroke. 1999 Jul;30(7):1350-6.
Racial inequity of access to carotid imaging.
Evans A, Kalra L.
Publication Types: Comment; Letter
PMID: 10548691 [PubMed - indexed for MEDLINE]
