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Differences in Out-of-Hospital Cardiac Arrest Outcomes Among 5 Racial/Ethnic Groups
Kenton L Anderson1, Monica R Saxena1, Loretta W Matheson1
1Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California.
Insights
Racial and ethnic disparities persist in out-of-hospital cardiac arrest (OHCA) survival. Black, Asian, Hispanic, and Pacific Islander patients had lower survival rates compared to White patients, indicating a critical need for equitable care.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Out-of-hospital cardiac arrest (OHCA) is a significant cause of mortality in adults.
- Existing research highlights racial/ethnic survival disparities in OHCA, but often focuses on single groups.
- Understanding these disparities across multiple groups is crucial for targeted interventions.
Purpose of the Study:
- To investigate OHCA variables and survival outcomes across five distinct racial/ethnic groups.
- To identify potential factors contributing to survival differences in OHCA patients.
- To provide a comprehensive analysis of racial/ethnic disparities in OHCA outcomes.
Main Methods:
- Retrospective review of adult OHCA cases from the Cardiac Arrest Registry to Enhance Survival (CARES).
- Data collected from three diverse urban counties in the San Francisco Bay Area (May 2009 - October 2021).
- Survival outcomes analyzed by demographics, EMS response, arrest characteristics, and hospital interventions, with adjusted risk ratios calculated.
Main Results:
- Analysis included 10,757 OHCA patients across White, Black, Asian, Hispanic, and Pacific Islander groups.
- Significantly lower adjusted risk ratios for survival to hospital discharge were observed in Black (0.79), Asian (0.78), Hispanic (0.79), and Pacific Islander (0.78) groups compared to White patients.
- All four minority groups also showed a lower risk difference for positive neurologic outcomes.
Conclusions:
- Black, Asian, Hispanic, and Pacific Islander individuals experiencing OHCA have a reduced likelihood of surviving to hospital discharge compared to White individuals.
- No specific variables consistently explained the decreased survival across these four racial/ethnic groups.
- These findings underscore persistent inequities in OHCA care and outcomes that require further investigation and targeted solutions.
Objective:
Out-of-hospital cardiac arrest (OHCA) is a major health problem and one of the leading causes of death in adults older than 40. Multiple prior studies have demonstrated survival disparities based on race/ethnicity, but most of these focus on a single racial/ethnic group. This study evaluated OHCA variables and outcomes among on 5 racial/ethnic groups.
Methods:
This is a retrospective review of data for adult patients in the Cardiac Arrest Registry to Enhance Survival (CARES) from 3 racially diverse urban counties in the San Francisco Bay Area from May 2009 to October 2021. Stratifying by 5 racial/ethnic groups, we evaluated patient survival outcomes based on patient demographics, emergency medical services response location, cardiac arrest characteristics, and hospital interventions. Adjusted risk ratios were calculated for survival to hospital discharge, controlling for sex, age, response locations, median income of response location, arrest witness, shockable rhythm, and bystander cardiopulmonary resuscitation as well as clustering by census tract.
Results:
There were 10,757 patient entries analyzed: 42% White, 24% Black, 18% Asian, 9.3% Hispanic, 6.0% Pacific Islander, 0.7% American Indian/Alaska Native, and 0.1% multiple races selected; however, only the first 5 racial/ethnic groups had sufficient numbers for comparison. The adjusted risk ratio for survival to hospital discharge was lower among the 4 racial/ethnic groups compared with the White reference group: Black (0.79, p = 0.003), Asian (0.78 p = 0.004), Hispanic (0.79, p = 0.018), and Pacific Islander (0.78, p = 0.041) groups. The risk difference for positive neurologic outcome was also lower among all 4 racial/ethnic groups compared with the White reference group.
Conclusions:
The Black, Asian, Hispanic, and Pacific Islander groups were less likely to survive to hospital discharge from OHCA when compared with the White reference group. No variables were associated with decreased survival across any of these 4 groups.
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