Navigation Links
Minorities have poorer results, higher rates of inappropriate surgery to prevent stroke
Date:8/25/2009

DALLAS Aug. 25, 2009 Minorities have poorer results and higher rates of unnecessary surgery from a common procedure used to remove plaque from inside the carotid artery, according to a UT Southwestern Medical Center doctor who is lead author of the study in the journal Stroke.

The multicenter study, available online and appearing in the July issue of the journal, found that higher rates of poor surgical outcomes for carotid endartectomy (CEA) a procedure performed to prevent stroke appeared to be due not only to elevated patient clinical risk in African-American and Hispanics, but also to the individual skill and experience of the doctor performing the operation.

"Identifying how various patient, physician and hospital-level factors may contribute to disparities has important implications for the design of clinical and health policy strategies for reducing them," said Dr. Ethan Halm, chief of the William T. and Gay F. Solomon Division of General Internal Medicine at UT Southwestern.

"To my knowledge this is the first study to examine the stepwise impact of patient, surgeon and hospital factors as a way of understanding racial/ethnic disparities in clinically confirmed outcomes of carotid artery surgery," he said.

Previous research has demonstrated that minority groups in the U.S. have higher rates of heart attack and stroke. For example, African-Americans have greater numbers and higher severity of strokes, accompanied by higher rates of recurrence or death within 30 days.

Yet Hispanics have not been well-studied as a subgroup, Dr. Halm said.

The researchers used data from the New York Carotid Artery Surgery (NYCAS) study to examine the medical outcomes of 9,093 Medicare patients who had undergone carotid endartectomy in New York state. Of the patients, 95.3 percent were Caucasian, 2.5 percent were African-American and 2.2 percent were Hispanic.

They found that the minorities had much worse clinical outcomes. In the 30 days following surgery, 9.5 percent of the Hispanic patients and 6.9 percent of the African-Americans had died or suffered a stroke due to the procedure, compared with 3.8 percent of Caucasian patients. One reason minorities had higher complications rates was that they had severe neurological disease and more serious health conditions like heart disease and diabetes.

However, minorities were more likely to be cared for by less-experienced surgeons and hospitals. Adjusting for these patient and provider factors explained the worse results in African-Americans, but did not explain the poorer outcomes in Hispanics.

Rates of unnecessary surgery were also higher in minorities. For Hispanics, CEA was inappropriate in 17.6 percent of the cases; for African-Americans, 13 percent; and for Caucasians, 7.9 percent. The disparity in rates of unnecessary surgery was largely due to the higher burden of serious health conditions among minorities, which put them at much higher short-term risk of complications. If the short-term risk of carotid surgery is too high, the procedure is considered inappropriate.

"These results show we have the worst of all worlds," Dr. Halm said. "CEA is, paradoxically, both overused and underused in minorities and with worse results. More work is needed to help better understand the multiple factors that influence patient selection and surgical referral patterns. Developing evidence-based decision aids to help physicians and patients more accurately weigh the potential risks and benefits of CEA is one strategy we are pursuing to help improve this situation."


'/>"/>

Contact: Erin Prather Stafford
erin.pratherstafford@utsouthwestern.edu
214-648-3404
UT Southwestern Medical Center
Source:Eurekalert

Related medicine news :

1. AADE, Emory University and Johnson & Johnson Diabetes Institute Partner to Educate and Improve Access to Care for Atlanta-area Minorities with Diabetes
2. HIV Atlas Shows Virus Targeting Minorities
3. Study finds segregation decreases access to surgical care for minorities
4. U.S. Civil Rights Commission to Hold Public Briefing on Health Care Disparities Between Minorities and Non-Minorities, and Business Meeting
5. M. D. Anderson study predicts dramatic growth in cancer rates among US elderly, minorities
6. Minorities to Bear Brunt of Rise in U.S. Cancer Cases
7. Economic Bad Times Put Minorities at Higher Crime Risk
8. Minorities Distrust Medical System More
9. Building trust, increasing awareness among minorities
10. Terror Fears Tougher on Minorities, Disabled
11. Town Hall Meeting on Inequities in Clinical Trials Documents Ongoing Tuskegee Effect When Recruiting Minorities for Research Studies
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/12/2016)... ... February 12, 2016 , ... Atlantic Information Services, Inc. (AIS) ... PBMs,” an upcoming Feb. 24 webinar that will discuss ways health plans and ... such as the $1,000-per-pill hepatitis C treatment Sovaldi and high-cost PCSK9 inhibitors to ...
(Date:2/12/2016)... ... February 12, 2016 , ... US Sport Camps is pleased to ... Club, located in Norwalk, serves as the host site and directing the camps is ... “We have had successful camps in recent years around Des Moines and are fortunate ...
(Date:2/12/2016)... , ... February 12, 2016 , ... Healthcare careers in ... five most searched jobs via the website of healthcare staffing leader Aureus Medical Group ... travel nurse jobs , travel therapy positions and in travel and direct ...
(Date:2/12/2016)... (PRWEB) , ... February 12, 2016 , ... ... creating explosive growth in the field of long term care. With that, says ... for well-trained healthcare professionals in administrative roles in long term care environments. His ...
(Date:2/12/2016)... ... February 12, 2016 , ... Basketball is a game for everyone, not just ... PoppersTM series, sign language translation is featured in the top right of the screen. ... PoppersTM lessons has a sign language translator to teach kids the game and how ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... Stem cells are primitive cells found in ... the capacity to differentiate into mature cell types Stem ... first mouse embryonic stem cells were derived from embryos ... the first culturing of embryonic stem cells from non-human ... until 2006 As a result of these discoveries, stem ...
(Date:2/11/2016)... N.Y. , Feb. 11, 2016  Governor Andrew ... that will create 1,400 jobs throughout Western ... a partnership with the SUNY Polytechnic Institute, includes a ... Conventus Building in Buffalo , as ... foot manufacturing facility in Dunkirk . ...
(Date:2/11/2016)... AAIPharma Services Corp./Cambridge Major Laboratories, Inc. ... development services for the pharmaceutical and biotechnology industries, ... in its Charleston, SC ... recent investments. Charleston ... with small-scale lyophilization. The site has invested in ...
Breaking Medicine Technology: