Oddone Eugene Z, Horner Ronnie D, Johnston Dean C C, Stechuchak Karen, McIntyre Lauren, Ward Aileen, Alley Linda G, Whittle Jeff, Kroupa Laura, Taylor John
Center for Health Services Research in Primary Care, Durham VAMC, Division of General Internal Medicine, Duke University Medical Center, Durham NC 27710, USA.
Stroke. 2002 Dec;33(12):2936-43. doi: 10.1161/01.str.0000043672.42831.eb.
Carotid endarterectomy (CE) has been proved to reduce the risk of stroke for certain patients, but black patients are less likely than whites to receive CE. The purpose of this work was to determine the importance of clinical indications and patient preferences in predicting the use of carotid angiography and CE in a racially stratified sample of patients.
Between 1997 and 1999, 708 patients with at least 1 carotid artery containing a >/=50% stenosis were enrolled (617 whites, 91 blacks) from 5 Veteran Affairs Medical Centers. Patient interviews were conducted at the time of the index carotid ultrasound, and each patient was followed up for 6 months to determine clinical events and receipt of carotid angiography or CE.
Black and white patients were similar in terms of age, sex, education level, and social support. More black than white patients received ultrasound for a completed stroke (36% versus 13%), and fewer black patients were classified as asymptomatic (56% versus 70%) or as having had a TIA (8% versus 17%; P<0.001). Health-related quality of life scores, trust in physician, and medical comorbidity scores were similar for black and white patients. Black patients expressed higher aversion to CE than white patients (31% versus 15% in the highest aversion quartile for blacks and whites, respectively; P=0.01). During follow-up, 20% of white patients and 14% of black patients received CE (P=0.19). In adjusted analyses, only patient clinical status as it relates to the indication for CE and site were associated with receipt of CE.
Contrary to prior research, patient's race was not associated with receipt of invasive carotid imaging or CE for older male veterans. These findings persist after controlling for patient preferences, comorbid illness, and quality of life. For patients enrolled in an equal-access health care system, clinical status was the primary determinant of the receipt of CE.
颈动脉内膜切除术（CE）已被证明可降低某些患者的中风风险，但黑人患者接受CE的可能性低于白人。这项研究的目的是确定在按种族分层的患者样本中，临床指征和患者偏好对预测颈动脉血管造影和CE使用情况的重要性。
1997年至1999年期间，从5个退伍军人事务医疗中心招募了708例至少有1条颈动脉狭窄≥50%的患者（617例白人，91例黑人）。在首次颈动脉超声检查时对患者进行访谈，并对每位患者随访6个月，以确定临床事件以及颈动脉血管造影或CE的接受情况。
黑人和白人患者在年龄、性别、教育水平和社会支持方面相似。因完全性中风接受超声检查的黑人患者多于白人患者（36%对13%），被归类为无症状的黑人患者较少（56%对70%）或有短暂性脑缺血发作的黑人患者较少（8%对17%；P<0.001）。黑人和白人患者的健康相关生活质量评分、对医生的信任度以及医疗合并症评分相似。黑人患者比白人患者对CE表现出更高的厌恶感（分别处于黑人与白人最高厌恶四分位数的患者中，黑人占31%，白人占15%；P=0.01）。随访期间，20%的白人患者和14%的黑人患者接受了CE（P=0.19）。在调整分析中，仅与CE指征和部位相关的患者临床状态与CE的接受情况有关。
与先前的研究相反，对于老年男性退伍军人，患者的种族与接受侵入性颈动脉成像或CE无关。在控制了患者偏好、合并疾病和生活质量后，这些发现仍然存在。对于纳入平等医疗保健系统的患者，临床状态是接受CE的主要决定因素。
