Data from: Lower carotid revascularization rates after stroke in ethnic minority-serving US hospitals

Objective: We sought to determine whether the use of carotid
revascularization procedures after 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 disease, identified by ICD9-CM codes, from 2007-2011 in the
Nationwide Inpatient Sample. The use of carotid endarterectomy (CEA) and
carotid artery stenting (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 26,189 ischemic stroke cases meeting inclusion
criteria, 20,870 (79.7%) were treated at 1,113 white hospitals, and 5,319
(20.3%) received care at 325 hospitals minority-serving hospitals.
Compared to patients in white hospitals, patients in minority hospitals
were less likely to undergo CEA/CAS (17.6%, 95% CI 16.6%-18.6%, in
minority vs. 21.2%, 95% CI 20.7%-21.8%, 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 0.81, 95%
CI 0.70-0.93), independent of individual patient race and other measured
hospital characteristics. Whites and Hispanics had significantly lower
odds of CEA/CAS in minority compared to white hospitals. Patient-level
racial differences in the use of carotid revascularization procedures
remained within each hospital stratum. Conclusions: The odds of 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.