Site of care linked to racial imaging disparities in stroke

By Eleanor McDermid

Patients with stroke are less likely to undergo carotid artery imaging if they are treated at a hospital that serves a population with a high proportion of minority ethnicities, say researchers.

This distinction applied regardless of patients' own ethnicities, report Eric Cheng (Veterans Affairs Greater Los Angeles Healthcare System, California, USA) and team in Neurology.

"This study is vitally important because it illustrates a potentially modifiable health systems factor which affects not only one race of patients but all patients treated at certain facilities," say Richard Benson and Jason Freeman (Washington Hospital Center, DC, USA), in a related editorial.

They add: "When considering health disparities, most automatically think about individual patient characteristics that might lead to differences in health care delivery or outcome without regard to factors related to health systems, political-, legislative-, or advertisement-related factors."

The study included 1534 White and 628 Black patients who were admitted to 127 Veterans Affairs Medical Centers in 2007.

The 13 hospitals in the top 10% of minority stroke admissions (ranked according to the proportion of Black patients admitted) together admitted 40% of the Black patients in the study. In these hospitals, 78.0% of White and 70.5% of Black patients underwent carotid artery imaging.

By contrast, 89.7% of White patients treated at the other hospitals underwent carotid artery imaging, as did 87.2% of Black patients.

The researchers expected these differences to be accounted for by less use of more advanced imaging technologies at the minority-serving hospitals. However, the findings "were driven by differential use of carotid ultrasound, an older, more inexpensive, and more universally available technology."

Carotid ultrasound was used in just 32.5% of patients treated in minority-serving hospitals, compared with 60.3% of those treated at other hospitals. The reverse pattern was seen for the more advanced technologies, with magnetic resonance angiography used in 40.5% versus 33.3% and computed tomography angiography used in 12.6% versus 8.2% of patients.

In their editorial, Benson and Freeman note that the study did not control for variable resources at the hospitals, saying it is "possible that the minority-serving hospitals have fewer resources and are unable to afford appropriate equipment or technicians to perform [carotid artery imaging]."

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