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The team performed a systematic review and meta-analysis, gathering evidence from 12 previously published research papers and synthesizing the outcomes data from 574,055 patients who underwent a carotid endarterectomy procedure from 1998 to 2022. They found that non-white patients have twice the risk of dying within 30-days of the procedure compared to white patients. They did not find a significant relationship between race and the risk of stroke in the studied timeframe.
“When we think of disparities, we consider differences between groups, but we shouldn’t ignore inequities, which are a much bigger problem,” Zil-E-Ali said. “If someone in their 30s or 40s, unaware of preventative measures, has never visited a doctor and ends up in the emergency room, that person may already be in an advanced stage of the disease. While a surgeon can address the immediate issue, the underlying problem is far larger than just one procedure.”
Surgery is just one point on the spectrum of care of medical management within a larger health care system. There is a myriad of factors, like geographic location, insurance coverage and socioeconomic status, that may contribute to structural inequities that may lead to disparities in access to care, the quality of care delivered and, ultimately, surgical outcomes, the researchers explained. These factors can contribute to characteristics associated with higher mortality like advanced disease, late access to care or prescription medication, lack of postoperative care and follow-up.
“We’ve always had a suspicion that people from different racial backgrounds seek care at different stages of disease with non-white patients seeking care at in the later stages of disease progression, which may influence outcomes,” said senior author Faisal Aziz, Elsie H. Sealfon professor and chief of vascular surgery at the Penn State College of Medicine. “This paper confirms what we see in clinic.”
The team members said they hope to build on this research and look at data on disparities in other vascular conditions and diseases.
Other Penn State College of Medicine authors include medical students Billal Alamarie, Abdul Wasay Paracha and Fadi Samaan.