UNDERSTANDING RACIAL VARIATION IN THE USE OF CAROTID ENDARTERECTOMY -THE ROLE OF AVERSION TO SURGERY

Previous studies indicate that African-American patients undergo carot id endarterectomy at one fourth the rate of white patients. This study was undertaken to determine if differences in aversion to carotid end arterectomy might account for some of the racial difference in utiliza tion of this procedure. A sample of 185 African-American and white pat ients was selected from a cohort of patients hospitalized for stroke o r transient ischemic attack at four Veterans Affairs medical centers. OF these patients, 115 (62%) were able to be contacted by telephone an d 95 (83%) agreed to be interviewed. The interview included assessment s of functional status, patient preferences for their current health s tatus, and risk aversion to a hypothetical carotid endarterectomy. Pat ients From both racial groups were similar in age, marital status, lev el of education, and comorbid medical illnesses. All respondents were male. Functional status for both groups was high and not statistically different. There were no significant racial differences in patients' perceptions of their current health state. However, African-American p atients expressed more aversion to the hypothetical surgery than white s. The median excess risk of death accepted to avoid surgery was 20% f or African Americans versus 2.5% for whites. These results indicate th at-racial differences in the utilization of carotid endarterectomy may be due in part to differences in patients' levels of aversion to this surgery.