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.