title: The impact of race and ethnicity on the outcome of carotid interventions in the United States.
abstract: OBJECTIVE
  Previous studies have demonstrated an adverse impact of African American race and Hispanic ethnicity on the outcomes of carotid endarterectomy (CEA), although little is known about the influence of race and ethnicity on the outcome of carotid angioplasty and stenting (CAS). The present study was undertaken to examine the influence of race and ethnicity on the outcomes of CEA and CAS in contemporary practice.
  
  
  METHODS
  The nationwide inpatient sample (2005-2008) was queried using International Classification of Diseases-9 codes for CEA and CAS in patients with carotid artery stenosis. The primary outcomes were postoperative death or stroke. Multivariate analysis was performed adjusting for age, gender, race, comorbidities, high-risk status, procedure type, symptomatic status, year, insurance type, and hospital characteristics.
  
  
  RESULTS
  Overall, there were 347,450 CEAs and 47,385 CASs performed in the United States over the study period. After CEA, Hispanics had the greatest risk of mortality (P < 0.001), whereas black patients had the greatest risk of stroke (P = 0.02) compared with white patients on univariate analysis. On multivariable analysis, Hispanic ethnicity remained an independent risk factor for mortality after CEA (relative risk 2.40; P < 0.001), whereas the increased risk of stroke in black patients was no longer significant. After CAS, there were no racial or ethnic differences in mortality. On univariate analysis, the risk of stroke was greatest in black patients after CAS (P = 0.03). However, this was not significant on multivariable analysis.
  
  
  CONCLUSIONS
  Hispanic ethnicity is an independent risk factor for mortality after CEA. While black patients had an increased risk of stroke after CEA and CAS, this was explained by factors other than race. Further studies are warranted to determine if Hispanic ethnicity remains an independent risk factor for mortality after discharge.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, Harvey 611, 600 N Wolfe Street, Baltimore, Maryland 21287, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: James H
authors.initials: JH
authors.lastname: Black
authors.forename: Hali L
authors.initials: HL
authors.lastname: Hambridge
authors.forename: Ying Wei
authors.initials: YW
authors.lastname: Lum
authors.forename: Julie A
authors.initials: JA
authors.lastname: Freischlag
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Perler
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Abularrage
mesh_terms: D001741:Black or African American; D000368:Aged; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology