Brain Imaging Disparities and Long-term Prognosis in White and Black Patients with Transient Ischemic Attacks
Anuttham Kandhadai1, Varun Rachakonda3, Paul Brindley2
1The University of Texas Medical Branch at Galveston, 2Psychiatry, The University of Texas Medical Branch at Galveston, 3Nova Southeastern University Kiran C. Patel College of Allopathic Medicine
Objective:
This study aims to compare the utilization rates of brain imaging tools and analyze the 5-year mortality and stroke rates among White and Black patients presenting with TIAs.
Background:
Transient ischemic attacks (TIAs) are transient episodes of neurological dysfunction caused by focal brain ischemia. Prompt imaging plays a crucial role in guiding management.
Design/Methods:
A retrospective cohort study was conducted using the TriNetX database. White and black patients with a diagnosis of a TIA were included in the study, while patients who faced healthcare barriers related to socioeconomic factors were excluded. The cohorts were matched based on age, sex, BMI, diabetes, cerebrovascular disease/function, lifestyle risk factors, and medication use. The utilization rates of different brain and neck imaging modalities within 3 months of their presentation with TIAs, as well as 5-year mortality and stroke rates, were compared between the two groups.
Results:
73,951 patients were included in each cohort. There was no significant difference in the utilization rate of transcranial doppler (TCD) between White and Black patients (RR: 0.92, 95% CI: 0.83-1.03). However, White patients had lower utilization rates of CT of the head or brain (RR: 0.83, 95% CI: 0.81-0.86), MRI of the brain (RR: 0.93, 95% CI: 0.90-0.95), and MRA of the head or neck (RR: 0.75, 95% CI: 0.72-0.78). In contrast, White patients had higher utilization rates of CTA (RR: 1.05, 95% CI: 1.01-1.10). Black patients were significantly more likely to experience cerebral infarctions within 5 years (RR: 1.14, 95% CI: 1.12-1.16). In contrast, White patients experienced a significantly higher 5-year mortality (RR: 1,11, 95% CI: 1.08-1.14).
Conclusions:
This study reveals disparities in the utilization of brain imaging modalities, 5-year stroke risk, and 5-year mortality rates among White and Black patients presenting with TIAs. Further research is warranted to explore factors contributing to these disparities and develop interventions to mitigate them.