Abstract
Background: Revascularization with either carotid endarterectomy (CEA) or carotid artery stenting (CAS) has been shown to decrease future stroke risk in eligible patients with ischemic stroke due to carotid artery stenosis. We sought to determine whether the use of carotid revascularization procedures after ischemic stroke due to carotid stenosis differs between minority-serving hospitals and hospitals serving predominantly white patients. Methods: We identified ischemic stroke cases due to carotid artery disease, identified by ICD9-CM codes, from 2007-2011 in the Nationwide Inpatient Sample. The use of carotid revascularization procedures, i.e. CEA and CAS, was recorded. Hospitals with ≥40% ethnic minority patients (minority-serving hospitals) were compared to hospitals with <40% minority patients (white hospitals). Logistic regression was used to evaluate the use of CEA/CAS among minority-serving and white hospitals. Results: Of the 21,135 ischemic stroke cases meeting inclusion criteria, 16,256 (76.9%) were treated at 827 white hospitals, and 4,879 (23.1%) received care at 284 minority-serving hospitals. Compared to patients in white hospitals, patients in minority hospitals were less likely to undergo CEA or CAS (18.3%, 95% CI 16.7%-19.9%, in minority vs. 21.6%, 95% CI 20.5%-22.8%, in white hospitals, p<0.001). In fully adjusted logistic regression models, the odds of CEA/CAS were lower in minority compared to white hospitals (OR 0.82, 95% CI 0.71-0.95), independent of individual patient race and other measured hospital characteristics. Patient-level racial differences in the use of carotid revascularization procedures remained within each hospital stratum. Conclusions: The odds of receiving carotid revascularization after stroke is lower in minority-serving compared to white hospitals, suggesting system-level factors as a major contributor to explain race disparities in the use of carotid revascularization.
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