Neurocritical Care

, Volume 9, Issue 1, pp 55–73

Racial and Ethnic Disparities in the Treatment of Cerebrovascular Diseases: Importance to the Practicing Neurosurgeon

  • Sonia V. Eden
  • Michele Heisler
  • Carmen Green
  • Lewis B. Morgenstern
Original Article

DOI: 10.1007/s12028-007-9039-6

Cite this article as:
Eden, S.V., Heisler, M., Green, C. et al. Neurocrit Care (2008) 9: 55. doi:10.1007/s12028-007-9039-6

Abstract

Objectives

In various surgical procedures, evidence for racial/ethnic disparities has continued to grow in recent years. Our purpose was to review the current literature regarding racial/ethnic disparities in the United States in the surgical treatment and outcome of three different cerebrovascular disease entities: carotid stenosis, intracranial aneurysm, and cerebral arteriovenous malformation (AVM).

Methods

We conducted an electronic search of literature published between January 1, 1966 and December 10, 2005 using MEDLINE (OVID), EMBASE, CINAHL, and Science Citation Index (Web of Science), along with manual reference checking, resulting in 313 screened items. Main outcome measures examined were racial/ethnic differences in procedure utilization rates and perioperative stroke, death, and complications.

Results

Out of 3,624,581 articles indexed in MEDLINE pertaining to the treatment of these 3 cerebrovascular diseases, 141 (0.004%) articles pertained to minority groups and 33 (0.001%) articles met search criteria for inclusion in this review. Two additional articles were found in other searched databases. Carotid endarterectomy was the focus of 30 articles, and 5 articles pertained to craniotomy for treatment of intracranial aneurysms. No articles were found that examined racial differences in AVM treatment. Our systematic review found evidence of racial disparities in the surgical treatment of patients with carotid stenosis and aneurysmal subarachnoid hemorrhage. The data, however, is limited and confounded.

Conclusion

Results of this comprehensive literature review suggest that racial disparities in cerebrovascular disease are understudied. Race-associated differences in neurosurgical outcomes must be documented and vigorously investigated to determine the basis of any observed differences and ensure that we are providing the best care possible to all of our patients.

Keywords

Carotid endarterectomy Carotid stenosis Cerebral arteriovenous malformation Cerebrovascular disease Health disparity Intracranial aneurysm Race/ethnicity 

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Sonia V. Eden
    • 1
  • Michele Heisler
    • 2
    • 3
  • Carmen Green
    • 4
  • Lewis B. Morgenstern
    • 1
    • 5
  1. 1.Department of NeurosurgeryUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Ann Arbor VA Center for Practice Management and Outcomes ResearchAnn ArborUSA
  4. 4.Department of AnesthesiologyUniversity of Michigan Health SystemAnn ArborUSA
  5. 5.Stroke ProgramUniversity of Michigan Health SystemAnn ArborUSA

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