| Background. Ischemic stroke disproportionately affects the black population. Carotid endarterectomy (CEA) is a surgical procedure proven to reduce the risk of ischemic stroke among patients with symptomatic severe carotid stenosis; however, CEA is performed less often for blacks compared to whites. The objective of the following three studies was to investigate the effect of black race on the receipt of diagnostic carotid imaging and CEA, which has not previously been examined within the elderly stroke population. First, a systematic review and meta-analysis were conducted. Then, in a nationwide sample of elderly ischemic stroke patients, the associations between race and receipt of carotid imaging and CEA were examined.;Methods. For the systematic review and meta-analysis, observational cohort studies of black and white individuals hospitalized for ischemic stroke were selected, with receipt of carotid imaging and/or CEA as the primary outcomes. The patient population for the two retrospective analyses included Medicare beneficiaries aged 65 years or older, discharged with an ischemic stroke diagnosis. The crude and risk adjusted associations between race and the receipt of any carotid imaging were assessed. For patients considered to be eligible for CEA based on their overall degree of stenosis, the association between race and receipt of CEA was examined.;Results. The meta-analysis found that black patients were less likely to receive any carotid imaging compared to whites (adjusted pooled OR 0.81, 95%CI (0.72, 0.91), and almost one-third as likely to receive CEA (adjusted pooled OR 0.37, 95%CI (0.29, 0.48). In the analyses of the Medicare ischemic stroke patient sample, black patients were less likely to receive any carotid imaging [adjusted OR 0.87, 95%CI (0.78, 0.97)]. However, race was unrelated to receipt of CEA after adjustment for carotid stenosis and other covariates [adjusted OR 1.14, 95%CI (0.66, 1.96)].;Conclusions. Black race was negatively associated with the likelihood of receipt of diagnostic procedures for stroke after adjusting for demographic and clinical characteristics. However, race was not associated with the receipt of CEA after adjustment for degree of stenosis. Racial differences in the receipt of diagnostic carotid imaging might influence the pool of patients considered eligible for CEA. |
