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Theories explaining racial differences in the utilization of diagnostic and therapeutic procedures for
R D Horner1, E Z Oddone, D B Matchar
1Center for Health Services Research in Primary Care (152), VA Medical Center, Durham, NC 27705, USA.
Insights
Blacks face higher stroke risks but receive fewer cerebrovascular diagnostic and treatment procedures, like carotid endarterectomy. This disparity may stem from less severe artery disease in Black patients, not just bias or cost.
Area of Science:
- Neurology
- Vascular Surgery
- Health Disparities
Background:
- Black populations exhibit a higher incidence of stroke compared to White populations.
- Invasive procedures, such as carotid endarterectomy, are crucial for diagnosing and treating cerebrovascular disease.
- Existing data reveal disparities in the utilization of these procedures between racial groups.
Purpose of the Study:
- To investigate the reasons behind the lower rates of cerebrovascular procedures in Black patients compared to White patients.
- To explore potential factors including racial bias, differing disease pathophysiology, economic constraints, and patient decision-making.
Main Methods:
- Review of existing literature and studies examining procedural rates for cerebrovascular disease.
- Analysis of factors potentially influencing procedural access and utilization across racial groups.
- Identification of research gaps, particularly concerning patient decision-making.
Main Results:
- Black patients are less likely to undergo carotid endarterectomy despite higher stroke risk.
- Black individuals tend to have less severe carotid artery atherosclerotic lesions, potentially reducing candidacy for the procedure.
- Financial affordability does not fully account for the observed disparities, though it may impact pre-hospitalization evaluations.
Conclusions:
- The lower utilization of cerebrovascular procedures in Black patients is multifactorial.
- Pathophysiological differences, specifically less severe atherosclerosis, play a role in reduced candidacy.
- Further research is needed to understand the impact of patient decisions on healthcare-seeking behaviors for cerebrovascular conditions.
Abstract:
Despite a higher risk of stroke, blacks are less likely than whites to receive the invasive procedures that are used to diagnose and treat cerebrovascular disease, particularly carotid endarterectomy. Explanations for the lower rate of procedural use include racial bias, racial differences in pathophysiology of cerebrovascular disease, affordability, and racial variation in patient decisions regarding care. Studies consistently indicate that blacks are less likely to have severe atherosclerotic lesions of the carotid arteries, reducing their likelihood of being appropriate candidates for carotid endarterectomy. Although ability to pay does not explain the observed variation in use of carotid endarterectomy, it may influence the evaluation process prior to hospitalization. A racial difference in patients' decisions about health care for cerebrovascular disease has never been investigated; it should be a topic of future studies.