This study aimed to explain the low rate of carotid endarterectomies in a busy surgical training program by examining the demographic makeup of patients undergoing this procedure. Data were collected from patients discharged with a primary or secondary procedure code of carotid endarterenctomy from the University Service in New Hanover Memorial Hospital during the period between January 1984 and December 1986. Data on race, age, sex and pay status were collected and compared with the respective data on the total discharged population for New Hanover Memorial Hospital, as well as to census data of New Hanover County and demographic data from five other teaching hospitals in North Carolina.

The results indicated that the percentage of blacks undergoing carotid endarterectomy in the study hospital was lower than the percentage of blacks among all hospital discharges and the percentage of blacks in the surrounding population. A lower percentage of patients receiving carotid endarterectomy were self-pay compared with the percentage of discharges from the study hospital that were self-pay.

The authors conclude that these data lend support to the concept that carotid disease in blacks tends to be intracranial rather than extracranial and further support the concept that extracranial atherosclerotic pattern of vascular disease may be a racial and/ or genetic feature. Further, they state that "it does not appear that blacks were denied access to health care, because although blacks were underrepresented among the carotid endarterectomy patients, they were equally represented among all hospital discharges." Pay status did not appear to selectively exclude blacks from undergoing carotid endarterectomy either.

These conclusions were made without supporting clinical data, data on patient preferences, or any consideration of potential bias in clinician’s treatment decisions.