Sex and Age-Based Disparities in Bystander Interventions for Out-of-Hospital Cardiac Arrest in Texas

Prior studies identify disparities in bystander interventions for female out-of-hospital cardiac arrest (OHCA) patients, particularly for those of reproductive age. We sought to evaluate for sex and reproductive age-based disparities in bystander interventions in Texas.

We retrospectively studied the 2013-2023 Texas Cardiac Arrest Registry to Enhance Survival OHCA registry, excluding OHCAs that occurred in healthcare facilities and nursing homes or were witnessed by 9-1-1 responders. We stratified OHCAs by sex and defined our outcomes at bystander cardiopulmonary resuscitation (BCPR) (in public and private locations), and bystander automated external defibrillator placement (BAED). We evaluated the association of sex on bystander interventions using logistic regression. Models were adjusted for race/ethnicity and bystander witnessed arrest. We performed sub-analyses comparing OHCAs that were and were not reproductive age (15-49 years old).

We included 50,484 OHCAs that met inclusion criteria; 18,602 were female, and 31,882 were male. Including patients of all ages, BCPR rates were similar for females compared to males in public (50.7% vs 51.2%, aOR 0.98 95% CI 0.87-1.07) and private (42.2% vs 42.1%, aOR 1.02 95% CI 0.98-1.06) locations. There were also no differences comparing patients of reproductive and non-reproductive age. Compared to males and including patients of all ages, odds of BAED was lower for females (5.2% vs 6.7%, aOR 0.76 95% CI 0.60-0.96). Odds of BAED was also lower for adult female OHCA patients of non-reproductive age (4.8% vs 7.4%, aOR 0.62 95% CI 0.46-0.82). However, BAED was similar for female OHCA patients of reproductive age.

Although we identified lower rates of bystander AED placement for female patients of non-reproductive age, we did not identify consistent sex and age-based disparities in bystander CPR.