Faculty Collaboration Database

Understanding racial variation in the use of carotid endarterectomy: the role of aversion to surgery. J Natl Med Assoc 1998 Jan;90(1):25-33

Date

02/25/1998

Pubmed ID

9473926

Pubmed Central ID

PMC2608306

Scopus ID

2-s2.0-0031605945 (requires institutional sign-in at Scopus site)   68 Citations

Abstract

Previous studies indicate that African-American patients undergo carotid endarterectomy at one fourth the rate of white patients. This study was undertaken to determine if differences in aversion to carotid endarterectomy might account for some of the racial difference in utilization of this procedure. A sample of 185 African-American and white patients was selected from a cohort of patients hospitalized for stroke or transient ischemic attack at four Veterans Affairs medical centers. Of these patients, 115 (62%) were able to be contacted by telephone and 95 (83%) agreed to be interviewed. The interview included assessments of functional status, patient preferences for their current health status, and risk aversion to a hypothetical carotid endarterectomy. Patients from both racial groups were similar in age, marital status, level of education, and comorbid medical illnesses. All respondents were male. Functional status for both groups was high and not statistically different. There were no significant racial differences in patients' perceptions of their current health state. However, African-American patients expressed more aversion to the hypothetical surgery than whites. The median excess risk of death accepted to avoid surgery was 20% for African Americans versus 2.5% for whites. These results indicate that racial differences in the utilization of carotid endarterectomy may be due in part to differences in patients' levels of aversion to this surgery.

Author List

Oddone EZ, Horner RD, Diers T, Lipscomb J, McIntyre L, Cauffman C, Whittle J, Passman LJ, Kroupa L, Heaney R, Matchar D

Author

Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Attitude
Endarterectomy, Carotid
Female
Health Status
Humans
Male
Middle Aged
Risk Assessment
Treatment Refusal
United States