The impact of race on outcomes after carotid endarterectomy in the United States
Black patients undergoing carotid endarterectomy (CEA) in the United States are more often symptomatic at presentation and have more comorbidities compared with white patients. However, the impact of race on outcomes after CEA is largely unknown. We identified CEA patients in the Vascular Quality In...
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| Veröffentlicht in: | Journal of vascular surgery 2018-08, Vol.68 (2), p.426-435 |
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| creator | Pothof, Alexander B. Soden, Peter A. Deery, Sarah E. O'Donnell, Thomas F.X. Wang, Grace J. Hughes, Kakra de Borst, Gert J. Schermerhorn, Marc L. |
| description | Black patients undergoing carotid endarterectomy (CEA) in the United States are more often symptomatic at presentation and have more comorbidities compared with white patients. However, the impact of race on outcomes after CEA is largely unknown.
We identified CEA patients in the Vascular Quality Initiative registry (2012-2017) and compared them by race (black vs white). All other nonwhite races (891 [1.4%]) and Hispanics (2222 [3.4%]) were excluded. We used multilevel logistic regression to account for differences in demographics and comorbidities. We assessed long-term survival using multivariable Cox regression. The primary outcome was perioperative stroke/death, with long-term survival as a secondary outcome.
We included 57,622 CEA patients; 2909 (5.0%) were black, of whom 983 (34%) were symptomatic. Of the 54,713 white patients, 16,132 (30%) were symptomatic. Black patients, compared with white patients, had a higher vascular disease burden and were less likely to be operated on in a high-volume hospital or by a high-volume surgeon. In addition, black symptomatic patients, compared with white symptomatic patients, were more often operated on |
| doi_str_mv | 10.1016/j.jvs.2017.11.087 |
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We identified CEA patients in the Vascular Quality Initiative registry (2012-2017) and compared them by race (black vs white). All other nonwhite races (891 [1.4%]) and Hispanics (2222 [3.4%]) were excluded. We used multilevel logistic regression to account for differences in demographics and comorbidities. We assessed long-term survival using multivariable Cox regression. The primary outcome was perioperative stroke/death, with long-term survival as a secondary outcome.
We included 57,622 CEA patients; 2909 (5.0%) were black, of whom 983 (34%) were symptomatic. Of the 54,713 white patients, 16,132 (30%) were symptomatic. Black patients, compared with white patients, had a higher vascular disease burden and were less likely to be operated on in a high-volume hospital or by a high-volume surgeon. In addition, black symptomatic patients, compared with white symptomatic patients, were more often operated on <2 weeks after the index neurologic symptom (47% vs 40%; P < .001). Perioperative stroke/death was comparable between black and white patients (symptomatic, 2.8% vs 2.2% [P = .2]; asymptomatic, 1.6% vs 1.3% [P = .2]), as was unadjusted survival at 3 years (93% vs 93%; P = .7). However, after adjustment, black patients did experience better long-term survival compared with white patients (hazard ratio, 0.8; 95% confidence interval, 0.7-0.9; P = .01). On multilevel logistic regression, race was not associated with perioperative stroke/death (odds ratio, 1.0; 95% confidence interval, 0.8-1.3; P = .98).
Despite the greater prevalence of vascular risk factors in black patients and racial inequalities in surgical treatment, rates of perioperative stroke/death and unadjusted survival were similar between white and black patients. Moreover, black patients experienced better adjusted long-term survival after CEA.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2017.11.087</identifier><identifier>PMID: 29482877</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>African Americans ; Aged ; Aged, 80 and over ; Carotid Artery Diseases - diagnostic imaging ; Carotid Artery Diseases - ethnology ; Carotid Artery Diseases - mortality ; Carotid Artery Diseases - surgery ; Chi-Square Distribution ; Comorbidity ; Endarterectomy, Carotid - adverse effects ; Endarterectomy, Carotid - mortality ; European Continental Ancestry Group ; Female ; Health Status Disparities ; Healthcare Disparities - ethnology ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Proportional Hazards Models ; Registries ; Retrospective Studies ; Risk Factors ; Stroke - ethnology ; Stroke - mortality ; Time Factors ; Treatment Outcome ; United States - epidemiology</subject><ispartof>Journal of vascular surgery, 2018-08, Vol.68 (2), p.426-435</ispartof><rights>2018 Society for Vascular Surgery</rights><rights>Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-fc7f16085fe80c67f8372d9181ea82ee95fed385b9cc0238ea6505cb873319943</citedby><cites>FETCH-LOGICAL-c396t-fc7f16085fe80c67f8372d9181ea82ee95fed385b9cc0238ea6505cb873319943</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2017.11.087$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,45978</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29482877$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pothof, Alexander B.</creatorcontrib><creatorcontrib>Soden, Peter A.</creatorcontrib><creatorcontrib>Deery, Sarah E.</creatorcontrib><creatorcontrib>O'Donnell, Thomas F.X.</creatorcontrib><creatorcontrib>Wang, Grace J.</creatorcontrib><creatorcontrib>Hughes, Kakra</creatorcontrib><creatorcontrib>de Borst, Gert J.</creatorcontrib><creatorcontrib>Schermerhorn, Marc L.</creatorcontrib><creatorcontrib>Society for Vascular Surgery Vascular Quality Initiative</creatorcontrib><title>The impact of race on outcomes after carotid endarterectomy in the United States</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Black patients undergoing carotid endarterectomy (CEA) in the United States are more often symptomatic at presentation and have more comorbidities compared with white patients. However, the impact of race on outcomes after CEA is largely unknown.
We identified CEA patients in the Vascular Quality Initiative registry (2012-2017) and compared them by race (black vs white). All other nonwhite races (891 [1.4%]) and Hispanics (2222 [3.4%]) were excluded. We used multilevel logistic regression to account for differences in demographics and comorbidities. We assessed long-term survival using multivariable Cox regression. The primary outcome was perioperative stroke/death, with long-term survival as a secondary outcome.
We included 57,622 CEA patients; 2909 (5.0%) were black, of whom 983 (34%) were symptomatic. Of the 54,713 white patients, 16,132 (30%) were symptomatic. Black patients, compared with white patients, had a higher vascular disease burden and were less likely to be operated on in a high-volume hospital or by a high-volume surgeon. In addition, black symptomatic patients, compared with white symptomatic patients, were more often operated on <2 weeks after the index neurologic symptom (47% vs 40%; P < .001). Perioperative stroke/death was comparable between black and white patients (symptomatic, 2.8% vs 2.2% [P = .2]; asymptomatic, 1.6% vs 1.3% [P = .2]), as was unadjusted survival at 3 years (93% vs 93%; P = .7). However, after adjustment, black patients did experience better long-term survival compared with white patients (hazard ratio, 0.8; 95% confidence interval, 0.7-0.9; P = .01). On multilevel logistic regression, race was not associated with perioperative stroke/death (odds ratio, 1.0; 95% confidence interval, 0.8-1.3; P = .98).
Despite the greater prevalence of vascular risk factors in black patients and racial inequalities in surgical treatment, rates of perioperative stroke/death and unadjusted survival were similar between white and black patients. Moreover, black patients experienced better adjusted long-term survival after CEA.</description><subject>African Americans</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carotid Artery Diseases - diagnostic imaging</subject><subject>Carotid Artery Diseases - ethnology</subject><subject>Carotid Artery Diseases - mortality</subject><subject>Carotid Artery Diseases - surgery</subject><subject>Chi-Square Distribution</subject><subject>Comorbidity</subject><subject>Endarterectomy, Carotid - adverse effects</subject><subject>Endarterectomy, Carotid - mortality</subject><subject>European Continental Ancestry Group</subject><subject>Female</subject><subject>Health Status Disparities</subject><subject>Healthcare Disparities - ethnology</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Proportional Hazards Models</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stroke - ethnology</subject><subject>Stroke - mortality</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFqGzEQhkVoiB0nD5BL0bGX3c5ovSuJnkpI0kCggThnIWtniYx35UqyIW8fGac99jQw8_0_zMfYDUKNgN33Tb05pFoAyhqxBiXP2BxBy6pToL-wOcglVq3A5YxdprQBQGyVvGAzoZdKKCnn7Hn1RtyPO-syDwOP1hEPEw_77MJIidshU-TOxpB9z2nqbSwLcjmM79xPPJf46-Qz9fwl20zpip0Pdpvo-nMu2Ov93er2V_X0--Hx9udT5Rrd5WpwcsAOVDuQAtfJQTVS9BoVklWCSJdD36h2rZ0D0SiyXQutWyvZNKj1slmwb6feXQx_9pSyGX1ytN3aicI-GQGglOoE6ILiCXUxpBRpMLvoRxvfDYI5ijQbU0Sao0iDaIrIkvn6Wb9fj9T_S_w1V4AfJ4DKkwdP0STnaXLU-6Me0wf_n_oPfCSDWg</recordid><startdate>201808</startdate><enddate>201808</enddate><creator>Pothof, Alexander B.</creator><creator>Soden, Peter A.</creator><creator>Deery, Sarah E.</creator><creator>O'Donnell, Thomas F.X.</creator><creator>Wang, Grace J.</creator><creator>Hughes, Kakra</creator><creator>de Borst, Gert J.</creator><creator>Schermerhorn, Marc L.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201808</creationdate><title>The impact of race on outcomes after carotid endarterectomy in the United States</title><author>Pothof, Alexander B. ; Soden, Peter A. ; Deery, Sarah E. ; O'Donnell, Thomas F.X. ; Wang, Grace J. ; Hughes, Kakra ; de Borst, Gert J. ; Schermerhorn, Marc L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-fc7f16085fe80c67f8372d9181ea82ee95fed385b9cc0238ea6505cb873319943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>African Americans</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carotid Artery Diseases - diagnostic imaging</topic><topic>Carotid Artery Diseases - ethnology</topic><topic>Carotid Artery Diseases - mortality</topic><topic>Carotid Artery Diseases - surgery</topic><topic>Chi-Square Distribution</topic><topic>Comorbidity</topic><topic>Endarterectomy, Carotid - adverse effects</topic><topic>Endarterectomy, Carotid - mortality</topic><topic>European Continental Ancestry Group</topic><topic>Female</topic><topic>Health Status Disparities</topic><topic>Healthcare Disparities - ethnology</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Proportional Hazards Models</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stroke - ethnology</topic><topic>Stroke - mortality</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pothof, Alexander B.</creatorcontrib><creatorcontrib>Soden, Peter A.</creatorcontrib><creatorcontrib>Deery, Sarah E.</creatorcontrib><creatorcontrib>O'Donnell, Thomas F.X.</creatorcontrib><creatorcontrib>Wang, Grace J.</creatorcontrib><creatorcontrib>Hughes, Kakra</creatorcontrib><creatorcontrib>de Borst, Gert J.</creatorcontrib><creatorcontrib>Schermerhorn, Marc L.</creatorcontrib><creatorcontrib>Society for Vascular Surgery Vascular Quality Initiative</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pothof, Alexander B.</au><au>Soden, Peter A.</au><au>Deery, Sarah E.</au><au>O'Donnell, Thomas F.X.</au><au>Wang, Grace J.</au><au>Hughes, Kakra</au><au>de Borst, Gert J.</au><au>Schermerhorn, Marc L.</au><aucorp>Society for Vascular Surgery Vascular Quality Initiative</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of race on outcomes after carotid endarterectomy in the United States</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2018-08</date><risdate>2018</risdate><volume>68</volume><issue>2</issue><spage>426</spage><epage>435</epage><pages>426-435</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Black patients undergoing carotid endarterectomy (CEA) in the United States are more often symptomatic at presentation and have more comorbidities compared with white patients. However, the impact of race on outcomes after CEA is largely unknown.
We identified CEA patients in the Vascular Quality Initiative registry (2012-2017) and compared them by race (black vs white). All other nonwhite races (891 [1.4%]) and Hispanics (2222 [3.4%]) were excluded. We used multilevel logistic regression to account for differences in demographics and comorbidities. We assessed long-term survival using multivariable Cox regression. The primary outcome was perioperative stroke/death, with long-term survival as a secondary outcome.
We included 57,622 CEA patients; 2909 (5.0%) were black, of whom 983 (34%) were symptomatic. Of the 54,713 white patients, 16,132 (30%) were symptomatic. Black patients, compared with white patients, had a higher vascular disease burden and were less likely to be operated on in a high-volume hospital or by a high-volume surgeon. In addition, black symptomatic patients, compared with white symptomatic patients, were more often operated on <2 weeks after the index neurologic symptom (47% vs 40%; P < .001). Perioperative stroke/death was comparable between black and white patients (symptomatic, 2.8% vs 2.2% [P = .2]; asymptomatic, 1.6% vs 1.3% [P = .2]), as was unadjusted survival at 3 years (93% vs 93%; P = .7). However, after adjustment, black patients did experience better long-term survival compared with white patients (hazard ratio, 0.8; 95% confidence interval, 0.7-0.9; P = .01). On multilevel logistic regression, race was not associated with perioperative stroke/death (odds ratio, 1.0; 95% confidence interval, 0.8-1.3; P = .98).
Despite the greater prevalence of vascular risk factors in black patients and racial inequalities in surgical treatment, rates of perioperative stroke/death and unadjusted survival were similar between white and black patients. Moreover, black patients experienced better adjusted long-term survival after CEA.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29482877</pmid><doi>10.1016/j.jvs.2017.11.087</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | African Americans Aged Aged, 80 and over Carotid Artery Diseases - diagnostic imaging Carotid Artery Diseases - ethnology Carotid Artery Diseases - mortality Carotid Artery Diseases - surgery Chi-Square Distribution Comorbidity Endarterectomy, Carotid - adverse effects Endarterectomy, Carotid - mortality European Continental Ancestry Group Female Health Status Disparities Healthcare Disparities - ethnology Humans Logistic Models Male Middle Aged Multivariate Analysis Odds Ratio Proportional Hazards Models Registries Retrospective Studies Risk Factors Stroke - ethnology Stroke - mortality Time Factors Treatment Outcome United States - epidemiology |
| title | The impact of race on outcomes after carotid endarterectomy in the United States |
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