ArticleStroke2009
Racial and ethnic disparities in outcomes and appropriateness of carotid endarterectomy: impact of patient and provider factors.
Article in Stroke, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it, 60 citations in OpenAlex.
- The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery.The Cochrane database of systematic reviews · 2021Pooled it
- Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map.Journal of the American College of Surgeons · 2019Pooled it
- Race/Ethnicity and overuse of care: a systematic review.The Milbank quarterly · 2015Pooled it
- Patient Race Independently Predicts Timeliness of Breast Cancer Reconstructive Care.Journal of clinical medicine · 2025Article
- Racial Differences in Adoption and Outcomes of Transcarotid Artery Revascularization among High-Risk Adults with Carotid Artery Stenosis.Annals of vascular surgery · 2025Article
- Socioeconomic status fails to account for worse outcomes in non-Hispanic black patients undergoing carotid revascularization.Journal of vascular surgery · 2023Article
- Association of Sex With the Use and Outcomes of Carotid Revascularization: A Cohort Study.Stroke (Hoboken, N.J.) · 2022Article
- Comorbidities Matter as Distressed Communities Index Fails to Predict Mortality in Necrotizing Soft Tissue Infection.Surgical infections · 2022Article
- Correlation of Patient Activation Measure Level with Patient Characteristics and Type of Vascular Disease.Annals of vascular surgery · 2021Article
- Review
- In-hospital outcomes alone underestimate rates of 30-day major adverse events after carotid artery stenting.Journal of vascular surgery · 2020Article
- Article
- Lower carotid revascularization rates after stroke in racial/ethnic minority-serving US hospitals.Neurology · 2019Article
- Early Carotid Endarterectomy after Acute Stroke Yields Excellent Outcomes: An Analysis of the Procedure-Targeted ACS-NSQIP.Annals of vascular surgery · 2019Article
- Risk Prediction Tools to Improve Patient Selection for Carotid Endarterectomy Among Patients With Asymptomatic Carotid Stenosis.JAMA surgery · 2019Article
- Improving hospital quality to reduce disparities in severe maternal morbidity and mortality.Seminars in perinatology · 2017Review
- Race as a predictor of delay from diagnosis to endarterectomy in clinically significant carotid stenosis.Journal of vascular surgery · 2015Article
- Incidence and risk factors for and the effect of a program to reduce the incidence of surgical site infection after cardiac surgery.Surgical infections · 2014Article
- Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors.Journal of the American College of Surgeons · 2013Review
- Ethnic differences in cardiovascular risks and mortality in atherothrombotic disease: insights from the Reduction of Atherothrombosis for Continued Health (REACH) registry.Mayo Clinic proceedings · 2011Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
background and purposePrior work documented racial and ethnic disparities in incidence of stroke, stroke risk factors, and use of carotid endarterectomy. Less is known about disparities in outcomes and appropriateness of carotid endarterectomy or reasons for such inequalities.
methodsThis was a population-based cohort of carotid endarterectomy performed in Medicare beneficiaries in New York. Clinical data were abstracted from medical charts to assess sociodemographics, clinical indication for carotid endarterectomy, disease severity, comorbidities, and deaths and strokes within 30 days of surgery. Appropriateness was based on validated criteria from a national expert panel. Differences in patients, providers, outcomes, and appropriateness were compared using chi(2) tests. Differences in risk-adjusted rates of death or nonfatal stroke were compared using multiple logistic regression accounting for patient, physician, and hospital-level risk factors.
resultsOverall, 95.3% of patients undergoing carotid endarterectomy were white, 2.5% black, and 2.2% Hispanic (N=9093). Minorities had more severe neurological disease and more comorbidities and were more likely to be cared for by lower-volume surgeons and hospitals (P<0.0001). Rates of 30-day death/stroke were higher in Hispanics (9.5%) and blacks (6.9%) than whites (3.8%; P<0.0001). Multivariable analyses that adjusted for presurgical patient risk and provider characteristics found that blacks no longer had significantly worse outcomes (OR=1.37; CI, 0.78 to 2.40), although the higher risk of death/stroke in Hispanics persisted (OR=1.87; CI, 1.09 to 3.19). Minorities had higher rates of inappropriate surgery (Hispanics 17.6%, black 13.0%, white 7.9%; P<0.0001) largely due to higher comorbidity.
conclusionsMinorities had worse outcomes and higher rates of inappropriate surgery. Differences in underlying presurgical risk factors and provider characteristics explained the higher risk of complications in blacks, but not Hispanics.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.