Lower use of carotid artery imaging at minority-serving hospitals.
OBJECTIVE
We determined whether site of care explains a previously identified racial disparity in carotid artery imaging.


METHODS
In this retrospective cohort study, data were obtained from a chart review of veterans hospitalized with ischemic stroke at 127 Veterans Administration hospitals in 2007. Extensive exclusion criteria were applied to obtain a sample who should have received carotid artery imaging. Minority-serving hospitals were defined as the top 10% of hospitals ranked by the proportion of stroke patients who were black. Population level multivariate logistic regression models with adjustment for correlation of patients in hospitals were used to calculate predictive probabilities of carotid artery imaging by race and minority-service hospital status. Bootstrapping was used to obtain 95% confidence intervals (CIs).


RESULTS
The sample consisted of 1,534 white patients and 628 black patients. Nearly 40% of all black patients were admitted to 1 of 13 minority-serving hospitals. No racial disparity in receipt of carotid artery imaging was detected within nonminority serving hospitals. However, the predicted probability of receiving carotid artery imaging for white patients at nonminority-serving hospitals (89.7%, 95% CI [87.3%, 92.1%]) was significantly higher than both white patients (78.0% [68.3%, 87.8%] and black patients (70.5% [59.3%, 81.6%]) at minority-serving hospitals.


CONCLUSIONS
Underuse of carotid artery imaging occurred most often among patients hospitalized at minority-serving hospitals. Further work is required to explore why site of care is a mechanism for racial disparities in this clinically important diagnostic test.
Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, USA. eric.cheng@va.gov
Eric M
EM
Cheng
Salomeh
S
Keyhani
Susan
S
Ofner
Linda S
LS
Williams
Paul L
PL
Hebert
Diana L
DL
Ordin
Dawn M
DM
Bravata
D000328:Adult; D044383:Black People; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups; D012189:Retrospective Studies; D014463:Ultrasonography; D014481:United States; D044465:White People; D001741:Black or African American