THEORIES EXPLAINING RACIAL-DIFFERENCES IN THE UTILIZATION OF DIAGNOSTIC AND THERAPEUTIC PROCEDURES FOR CEREBROVASCULAR-DISEASE

Despite a higher risk of stroke, blacks are less likely than whites to receive the invasive procedures that are used to diagnose and treat c erebrovascular disease, particularly carotid endarterectomy. Explanati ons for the lower rate of procedural use include racial bias, racial d ifferences in pathophysiology of cerebrovascular disease, affordabilit y, and racial variation in patient decisions regarding care. Studies c onsistently indicate that blacks are less likely to have severe athero sclerotic lesions of the carotid arteries, reducing their likelihood o f being appropriate candidates for carotid endarterectomy. Although ab ility to pay does not explain the observed variation in use of carotid endarterectomy, it may influence the evaluation process prior to hosp italization. A racial difference in patients' decisions about health c are for cerebrovascular disease has never been investigated; it should be a topic of future studies.