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Classifying Race in Out-of-Hospital Cardiac Arrest and Potential Disparities: A Retrospective Cohort Study
Jenny Shin1, Jennifer Liu1, Megin Parayil1
1Division of Emergency Medical Services, Public Health - Seattle & King County, WA (J.S., J.L., M.P., C.D., J.B., S.G., P.K., T.R.).
Circulation. Cardiovascular Quality and Outcomes
|January 23, 2025
Summary
Race misclassification in out-of-hospital cardiac arrest (OHCA) impacts survival analysis. Comprehensive race data reveals survival disparities not seen with emergency medical services (EMS) race data.
Area of Science:
- Emergency Medicine
- Public Health
- Health Disparities
Background:
- Racial disparities in resuscitation outcomes are documented.
- Limited understanding exists regarding potential bias in race classification for out-of-hospital cardiac arrest (OHCA).
Purpose of the Study:
- To assess agreement and missingness patterns in race classification between emergency medical services (EMS) and comprehensive records for OHCA patients.
- To analyze the association between race and OHCA survival using different race classification sources.
Main Methods:
- Retrospective cohort study of adult OHCA patients in King County, WA (2018-2021).
- Comparison of EMS-assessed race with comprehensive race data from hospital and death records.
- Multivariable logistic regression adjusted for Utstein data elements to analyze survival associations.
Main Results:
- EMS lacked race data for 43.7% of patients, with higher missingness in non-White racial groups.
- Agreement between EMS and comprehensive race classification was substantial (κ=0.88) but lowest for American Indian/Alaska Native individuals.
- Comprehensive race data revealed significantly lower OHCA survival odds for Native Hawaiian/other Pacific Islander and multiracial individuals compared to White individuals, an association not found using EMS-classified race.
Conclusions:
- Race misclassification and missingness in OHCA data significantly influence survival associations.
- There is a need for improved, comprehensive race classification practices in emergency medical services to accurately assess survival outcomes.
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