Association of Racial Residential Segregation and Survival After Out-of-Hospital Cardiac Arrest in the United States

Social determinants of health such as residential segregation have been identified as drivers of disparities in health outcomes; however, this has been understudied for out-of-hospital cardiac arrest (OHCA). We sought to examine whether there were differences in survival to discharge and survival with good neurological outcome, as well as likelihood of bystander cardiopulmonary resuscitation, using validated measures of racial, ethnic, and economic segregation.

We conducted a retrospective observational study using data from the Cardiac Arrest Registry to Enhance Survival data set. The primary predictor for this study was the Index of Concentration at the Extremes. The primary outcomes were survival to discharge and survival with good neurological status.

During the study period, 626 264 had an out-of-hospital cardiac arrest, and patients had a mean age of 62 years (SD 17.2 years). In multivariable models, we observed an increased likelihood of survival to discharge and survival with good neurological outcome for those patients residing in more highly segregated predominately White population and higher-income census tracts as compared with more highly segregated and lower-income Black and Hispanic/Latinx population census tracts. We found that the magnitude of this disparity was 24% for the outcome of survival to discharge as compared with reference (relative risk,1.24 [95% CI, 1.20-1.28]).

This research suggests that areas impacted by residential and economic segregation are important targets for both public policy interventions as well as addressing disparities in care across the chain of survival for out-of-hospital cardiac arrest.