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A new study reveals that non-white patients are twice as likely as white patients to die within 30 days of carotid endarterectomy, a common surgical procedure to reduce stroke risk. Despite advancements in medical practice, these racial disparities in outcomes have persisted for decades, highlighting systemic inequities in healthcare delivery.
Researchers at the Penn State College of Medicine conducted the first meta-analysis to examine racial disparities in carotid endarterectomy outcomes. Analyzing data from over 574,000 patients across 12 studies spanning 25 years, the study found that non-white patients face a twofold higher risk of mortality within 30 days of the procedure compared to their white counterparts.
Carotid endarterectomy, a widely performed surgery to remove plaque from the carotid artery, has long been associated with improving stroke outcomes. However, this study underscores that these benefits are not evenly distributed. “Twice the risk is a big risk,” said Ahsan Zil-E-Ali, a research fellow and an author of the study. “The fact that this increased risk is the same throughout the studies over the years surprised our group. Why are we not able to fix this problem?”
Interestingly, the analysis found no significant racial differences in the risk of stroke during the same timeframe, suggesting that the mortality disparity is driven by other factors beyond the surgical event itself.
The persistence of these disparities raises questions about the structural inequities that continue to influence patient outcomes, including differences in access to care, disease stage at the time of treatment, and postoperative follow-up. These inequities are shaped by socioeconomic status, geographic barriers, and variations in healthcare quality.
As lead researchers noted, non-white patients may seek care later in disease progression, which contributes to poorer surgical outcomes. "While a surgeon can address the immediate issue, the underlying problem is far larger than just one procedure,” Zil-E-Ali emphasized. These findings align with broader evidence of preventable disparities in healthcare, where outcomes for minority populations are consistently worse due to systemic challenges.
Senior author Faisal Aziz, chief of vascular surgery at Penn State College of Medicine, reinforced the importance of addressing these inequities. “This paper confirms what we see in clinic,” Aziz said, highlighting how social determinants of health influence both the timing and quality of care received by non-white patients.
The study calls for continued research into disparities across other vascular conditions and for actionable solutions to address inequities within healthcare systems. Without systemic change, the mortality gap is unlikely to close, leaving minority populations at greater risk of poor surgical outcomes.