Horner R D, Oddone E Z, Matchar D B
Center for Health Services Research in Primary Care (152), VA Medical Center, Durham, NC 27705, USA.
Milbank Q. 1995;73(3):443-62.
Despite a higher risk of stroke, blacks are less likely than whites to receive the invasive procedures that are used to diagnose and treat cerebrovascular disease, particularly carotid endarterectomy. Explanations for the lower rate of procedural use include racial bias, racial differences in pathophysiology of cerebrovascular disease, affordability, and racial variation in patient decisions regarding care. Studies consistently indicate that blacks are less likely to have severe atherosclerotic lesions of the carotid arteries, reducing their likelihood of being appropriate candidates for carotid endarterectomy. Although ability to pay does not explain the observed variation in use of carotid endarterectomy, it may influence the evaluation process prior to hospitalization. A racial difference in patients' decisions about health care for cerebrovascular disease has never been investigated; it should be a topic of future studies.
尽管中风风险较高，但与白人相比，黑人接受用于诊断和治疗脑血管疾病的侵入性手术的可能性较小，尤其是颈动脉内膜切除术。手术使用率较低的原因包括种族偏见、脑血管疾病病理生理学的种族差异、可负担性以及患者在医疗护理决策方面的种族差异。研究一致表明，黑人发生颈动脉严重动脉粥样硬化病变的可能性较小，这降低了他们成为颈动脉内膜切除术合适候选者的可能性。虽然支付能力无法解释观察到的颈动脉内膜切除术使用差异，但它可能会影响住院前的评估过程。从未有人研究过患者在脑血管疾病医疗护理决策方面的种族差异；这应该是未来研究的一个课题。
