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Blacks hospitalized for ministrokes are less likely than whites to receive diagnostic tests, see a specialist, or have surgery

A recent study by the Stroke Prevention Patient Outcomes Research Team (PORT) indicates that racial differences exist in treatment of patients at risk for stroke. Black patients hospitalized with transient ischemic attacks (TIAs, also called ministrokes) are significantly less likely than comparable white patients to receive diagnostic testing and surgery to prevent stroke and to have a neurologist as their attending physician. These findings are compatible with the documented gap between blacks and whites in receipt of cardiac tests and procedures.

Under the leadership of David Matchar, M.D., of Duke University and with support from the Agency for Healthcare Research and Quality (PORT contract 290-91-0028), the PORT researchers analyzed Medicare inpatient hospital records to identify a random 20 percent sample of elderly patients who were hospitalized with TIA in 1991. They found that blacks were significantly less likely than whites to receive cerebral angiography (40 vs. 48 percent), anticoagulant therapy (21 vs. 35 percent), or carotid endarterectomy (0.5 vs. 2 percent). Even blacks who received noninvasive diagnostic tests had about half (0.54) the odds of whites of undergoing cerebral angiography, and the black patients who did undergo this procedure had one-fourth the odds (0.27) of receiving carotid endarterectomy (surgical removal of plaque blocking the carotid artery in the neck).

These black-white differences in utilization of services for cerebrovascular disease largely persisted even after controlling for patient characteristics, comorbidity (other diseases), and ability to pay. One reason for the difference may be that blacks were less likely than whites to have a neurologist as an attending physician (24.7 vs. 28.8 percent). The investigators found that patients treated by neurologists were significantly more likely to be referred for cerebrovascular testing and to receive anticoagulant therapy but less likely to undergo carotid endarterectomy. Other explanations may lie in racial differences in the etiology of cerebrovascular disease (e.g., blacks being less likely to have extracranial disease amenable to carotid endarterectomy) or in patient preferences. More research is needed on how patients are referred to specialists and on possible racial or sociocultural differences in health beliefs that could affect the willingness of patients to undergo tests and procedures.

See "Racial variation in treatment for transient ischemic attacks: Impact of participation by neurologists," by Janet B. Mitchell, Ph.D., David J. Ballard, M.D., Ph.D., and others, in the March 2000 Health Services Research 34(7), pp. 1413-1428.

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