Race and sex-based disparities associated with carotid endarterectomy in the Atherosclerosis Risk in Communities (ARIC) study

Research output: Contribution to journalArticle

Abstract

Background and aims: The indications for carotid endarterectomy (CEA) are well established. The aim of the current study was to investigate sex and race-based disparities in the incidence of CEA after adjusting for carotid artery stenosis risk factors. Methods: We conducted a prospective cohort analysis of 14,492 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study without prevalent stroke at baseline (1987–1989). We used Kaplan-Meier curves and Cox proportional hazards models adjusting for sociodemographic, cardiovascular, and disease severity risk factors to quantify the associations of sex and race with incident CEA. Results: CEA was performed in 330 of 14,492 ARIC participants during a median of 27 years of follow-up [incidence rate 1.00 (95% CI 0.90–1.12) per 1000 persons-years]. The crude incidence of CEA varied significantly by sex [female vs. male: HR 0.60 (95% CI 0.48–0.74)] and race [black vs. white: HR 0.65 (95% CI 0.49–0.86)]. Adjustment for sociodemographic and cardiovascular risk factors, carotid intima-media thickness, and symptomatic status attenuated the association of sex with CEA [females vs. males HR 0.96 (0.76–1.22)], but black participants had a lower risk of incident CEA after adjustment [HR 0.68 (95% CI 0.49–0.95)]. Conclusions: We found significant variation in the incidence of CEA procedures based on race that was independent of traditional risk factors and carotid IMT. Whether this disparity is a reflection of differences in disease presentation or access to care deserves investigation.

Original languageEnglish (US)
Pages (from-to)10-16
Number of pages7
JournalAtherosclerosis
Volume292
DOIs
StatePublished - Jan 2020

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Carotid Endarterectomy
Atherosclerosis
Incidence
Carotid Intima-Media Thickness
Carotid Stenosis
Proportional Hazards Models
Cohort Studies
Cardiovascular Diseases
Stroke

Keywords

  • Carotid artery stenosis
  • Carotid endarterectomy
  • Disparities
  • Race
  • Sex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Race and sex-based disparities associated with carotid endarterectomy in the Atherosclerosis Risk in Communities (ARIC) study",
abstract = "Background and aims: The indications for carotid endarterectomy (CEA) are well established. The aim of the current study was to investigate sex and race-based disparities in the incidence of CEA after adjusting for carotid artery stenosis risk factors. Methods: We conducted a prospective cohort analysis of 14,492 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study without prevalent stroke at baseline (1987–1989). We used Kaplan-Meier curves and Cox proportional hazards models adjusting for sociodemographic, cardiovascular, and disease severity risk factors to quantify the associations of sex and race with incident CEA. Results: CEA was performed in 330 of 14,492 ARIC participants during a median of 27 years of follow-up [incidence rate 1.00 (95{\%} CI 0.90–1.12) per 1000 persons-years]. The crude incidence of CEA varied significantly by sex [female vs. male: HR 0.60 (95{\%} CI 0.48–0.74)] and race [black vs. white: HR 0.65 (95{\%} CI 0.49–0.86)]. Adjustment for sociodemographic and cardiovascular risk factors, carotid intima-media thickness, and symptomatic status attenuated the association of sex with CEA [females vs. males HR 0.96 (0.76–1.22)], but black participants had a lower risk of incident CEA after adjustment [HR 0.68 (95{\%} CI 0.49–0.95)]. Conclusions: We found significant variation in the incidence of CEA procedures based on race that was independent of traditional risk factors and carotid IMT. Whether this disparity is a reflection of differences in disease presentation or access to care deserves investigation.",
keywords = "Carotid artery stenosis, Carotid endarterectomy, Disparities, Race, Sex",
author = "Hicks, {Caitlin W.} and Daya, {Natalie R.} and Black, {James H.} and Kunihiro Matsushita and Elizabeth Selvin",
year = "2020",
month = "1",
doi = "10.1016/j.atherosclerosis.2019.10.019",
language = "English (US)",
volume = "292",
pages = "10--16",
journal = "Atherosclerosis",
issn = "0021-9150",
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T1 - Race and sex-based disparities associated with carotid endarterectomy in the Atherosclerosis Risk in Communities (ARIC) study

AU - Hicks, Caitlin W.

AU - Daya, Natalie R.

AU - Black, James H.

AU - Matsushita, Kunihiro

AU - Selvin, Elizabeth

PY - 2020/1

Y1 - 2020/1

N2 - Background and aims: The indications for carotid endarterectomy (CEA) are well established. The aim of the current study was to investigate sex and race-based disparities in the incidence of CEA after adjusting for carotid artery stenosis risk factors. Methods: We conducted a prospective cohort analysis of 14,492 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study without prevalent stroke at baseline (1987–1989). We used Kaplan-Meier curves and Cox proportional hazards models adjusting for sociodemographic, cardiovascular, and disease severity risk factors to quantify the associations of sex and race with incident CEA. Results: CEA was performed in 330 of 14,492 ARIC participants during a median of 27 years of follow-up [incidence rate 1.00 (95% CI 0.90–1.12) per 1000 persons-years]. The crude incidence of CEA varied significantly by sex [female vs. male: HR 0.60 (95% CI 0.48–0.74)] and race [black vs. white: HR 0.65 (95% CI 0.49–0.86)]. Adjustment for sociodemographic and cardiovascular risk factors, carotid intima-media thickness, and symptomatic status attenuated the association of sex with CEA [females vs. males HR 0.96 (0.76–1.22)], but black participants had a lower risk of incident CEA after adjustment [HR 0.68 (95% CI 0.49–0.95)]. Conclusions: We found significant variation in the incidence of CEA procedures based on race that was independent of traditional risk factors and carotid IMT. Whether this disparity is a reflection of differences in disease presentation or access to care deserves investigation.

AB - Background and aims: The indications for carotid endarterectomy (CEA) are well established. The aim of the current study was to investigate sex and race-based disparities in the incidence of CEA after adjusting for carotid artery stenosis risk factors. Methods: We conducted a prospective cohort analysis of 14,492 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study without prevalent stroke at baseline (1987–1989). We used Kaplan-Meier curves and Cox proportional hazards models adjusting for sociodemographic, cardiovascular, and disease severity risk factors to quantify the associations of sex and race with incident CEA. Results: CEA was performed in 330 of 14,492 ARIC participants during a median of 27 years of follow-up [incidence rate 1.00 (95% CI 0.90–1.12) per 1000 persons-years]. The crude incidence of CEA varied significantly by sex [female vs. male: HR 0.60 (95% CI 0.48–0.74)] and race [black vs. white: HR 0.65 (95% CI 0.49–0.86)]. Adjustment for sociodemographic and cardiovascular risk factors, carotid intima-media thickness, and symptomatic status attenuated the association of sex with CEA [females vs. males HR 0.96 (0.76–1.22)], but black participants had a lower risk of incident CEA after adjustment [HR 0.68 (95% CI 0.49–0.95)]. Conclusions: We found significant variation in the incidence of CEA procedures based on race that was independent of traditional risk factors and carotid IMT. Whether this disparity is a reflection of differences in disease presentation or access to care deserves investigation.

KW - Carotid artery stenosis

KW - Carotid endarterectomy

KW - Disparities

KW - Race

KW - Sex

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JF - Atherosclerosis

SN - 0021-9150

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