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In persons aged 65 years and over,the rate of carotid endarterectomy increased rapidly between 1980 and 1983 with a slight further increase through 1985.A marked fall in the rate occurred between 1985 and 1988, followed by a plateau and a sharp upturn in 1992.After 1985,there was a steady decline in the rate of cerebral arteriography procedures in hospital.No reliable data were available on outpatient cerebral arteriography.Throughout the period,whites had estimated rates of carotid endarterectomy procedures over four times higher than blacks.Whites also had higher rates or cerebral arteriography,but the disparity was not as great as for endarterectomy.Rates of carotid endarterectomy were 60%higher in men than women,but rates of cerebral arteriography were only 9%higher in men than women.Rates of carotid endarterectomy increased sharply after the 1991 publication of trail results.Marked racial disparities in the use of this procedure persist and require further evaluation. |
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