title: Hispanic ethnicity is associated with increased costs after carotid endarterectomy and carotid stenting in the United States.
abstract: OBJECTIVE
  We have previously demonstrated an adverse impact of black race and Hispanic ethnicity on the outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS). The current study was undertaken to examine the influence of race and ethnicity on the cost of CEA and CAS.
  
  
  METHODS
  The Nationwide Inpatient Sample (2005-2009) was queried using ICD-9 codes for CEA and CAS in patients with carotid artery stenosis. The primary outcome was total hospital charges. Multivariate analysis was performed using a generalized linear model adjusting for age, sex, race, comorbidities (Charlson index), high-risk status, procedure type, symptomatic status, year, insurance type, and surgeon and hospital operative volumes and characteristics.
  
  
  RESULTS
  Hispanic and black patients were more likely to have a symptomatic presentation, and were more likely to undergo either CEA or CAS by low-volume surgeons at low-volume hospitals (P < 0.05, all). They were also less likely to have private insurance or Medicare (P < 0.001). Overall, CEA was less expensive than CAS over the 4-y study period ($29,502 ± $104 versus $46,713 ± $409, P < 0.001). Total hospital charges after CEA were increased in both blacks ($39,562 ± $843) and Hispanics ($45,325 ± $735) compared with whites on univariate analysis ($28,403 ± $101, P < 0.001). After CAS, total hospital charges were similarly increased in both blacks ($51,770 ± $2085) and Hispanics ($63,637 ± $2766) compared with whites on univariate analysis ($45,550 ± $412, P < 0.001). On multivariable analysis, however, only Hispanic ethnicity remained independently associated with increased charges after both CEA (exponentiated coefficient 1.18; 95% CI [1.15-1.20]; P < 0.001) and CAS (exponentiated coefficient 1.17; 95% CI [1.09-1.24]; P < 0.001).
  
  
  CONCLUSIONS
  Hispanic ethnicity was independently associated with increased hospital charges after both CEA and CAS. The increased charges seen in black patients were explained, in part, by decreased surgeon operative volume and increased postoperative complications. Further efforts are warranted to contain costs in minorities undergoing carotid revascularization.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Propper
authors.forename: James H
authors.initials: JH
authors.lastname: Black
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Ying Wei
authors.initials: YW
authors.lastname: Lum
authors.forename: Mahmoud B
authors.initials: MB
authors.lastname: Malas
authors.forename: Margaret W
authors.initials: MW
authors.lastname: Arnold
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Abularrage
mesh_terms: D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D016893:Carotid Stenosis / Q000191:economics / Q000208:ethnology / Q000601:surgery; D015897:Comorbidity; D016894:Endarterectomy, Carotid / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D006278:Medicare / Q000191:economics / Q000592:standards; D015607:Stents / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
keywords: Carotid; Cost; Endarterectomy; Racial disparity; Stent