The impact of race and ethnicity on the outcome of carotid interventions in the United States

Abstract Objective Previous studies have demonstrated an adverse impact of African American race and Hispanic ethnicity on the outcomes of carotid endarterectomy (CEA), although little is known about the influence of race and ethnicity on the outcome of carotid angioplasty and stenting (CAS). The pr...

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Bibliographic Details
Published in:The Journal of surgical research 2012-09, Vol.177 (1), p.172-177
Main Authors: Schneider, Eric B., PhD, Black, James H., MD, Hambridge, Hali L., BS, Lum, Ying Wei, MD, Freischlag, Julie A., MD, Perler, Bruce A., MD, Abularrage, Christopher J., MD
Format: Article
Language:English
Subjects:
African Americans
Aged
Carotd
Endarterctomy
Endarterectomy, Carotid - adverse effects
Endarterectomy, Carotid - mortality
Female
Hispanic Americans
Humans
Male
Mortality
Multivariate Analysis
Nationwide Inpatient Sample
Stent
Stroke
Stroke - epidemiology
Stroke - etiology
Surgery
Treatment Outcome
United States - epidemiology
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Summary:Abstract Objective Previous studies have demonstrated an adverse impact of African American race and Hispanic ethnicity on the outcomes of carotid endarterectomy (CEA), although little is known about the influence of race and ethnicity on the outcome of carotid angioplasty and stenting (CAS). The present study was undertaken to examine the influence of race and ethnicity on the outcomes of CEA and CAS in contemporary practice. Methods The nationwide inpatient sample (2005–2008) was queried using International Classification of Diseases-9 codes for CEA and CAS in patients with carotid artery stenosis. The primary outcomes were postoperative death or stroke. Multivariate analysis was performed adjusting for age, gender, race, comorbidities, high-risk status, procedure type, symptomatic status, year, insurance type, and hospital characteristics. Results Overall, there were 347,450 CEAs and 47,385 CASs performed in the United States over the study period. After CEA, Hispanics had the greatest risk of mortality ( P < 0.001), whereas black patients had the greatest risk of stroke ( P = 0.02) compared with white patients on univariate analysis. On multivariable analysis, Hispanic ethnicity remained an independent risk factor for mortality after CEA (relative risk 2.40; P < 0.001), whereas the increased risk of stroke in black patients was no longer significant. After CAS, there were no racial or ethnic differences in mortality. On univariate analysis, the risk of stroke was greatest in black patients after CAS ( P = 0.03). However, this was not significant on multivariable analysis. Conclusion Hispanic ethnicity is an independent risk factor for mortality after CEA. While black patients had an increased risk of stroke after CEA and CAS, this was explained by factors other than race. Further studies are warranted to determine if Hispanic ethnicity remains an independent risk factor for mortality after discharge.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2012.02.050