Racial and Ethnic Disparities in the Treatment of Cerebrovascular Diseases: Importance to the Practicing Neurosurgeon
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- Eden, S.V., Heisler, M., Green, C. et al. Neurocrit Care (2008) 9: 55. doi:10.1007/s12028-007-9039-6
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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).
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.
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.
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.