Pediatric out-of-hospital cardiac arrest outcomes by Child Opportunity Index, race and ethnicity
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Published on: May 26, 2023
Jessica A Barreto1, Nishma Valikodath2, Jessica P Liu3
1Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
Insights
Children in disadvantaged neighborhoods and Black children have worse out-of-hospital cardiac arrest outcomes. Lower bystander response rates partially explain these disparities in pediatric cardiac arrest survival.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Cardiovascular Research
Background:
- Pediatric out-of-hospital cardiac arrest (OHCA) outcomes vary significantly across socioeconomic and racial groups.
- Understanding the impact of neighborhood-level factors and race on pediatric OHCA is crucial for targeted interventions.
Purpose of the Study:
- To examine the association between the Child Opportunity Index (COI), race/ethnicity, and pediatric OHCA survival.
- To investigate the mediating role of bystander response (cardiopulmonary resuscitation and defibrillator use) in these disparities.
Main Methods:
- Retrospective cohort study utilizing the Cardiac Arrest Registry to Enhance Survival (CARES) database.
- Analysis included children (≤18 years) with OHCA, assessing COI quintiles and race/ethnicity as exposures.
- Logistic regression and mediation analysis were employed to determine associations and the indirect effect of bystander response.
Main Results:
- Children in lower COI neighborhoods and Black/African American children experienced OHCA less frequently with bystander response.
- Lower COI (aOR 0.68) and Black/African American race (aOR 0.81) were independently associated with reduced odds of favorable neurological survival.
- Bystander response partially mediated the poorer outcomes associated with lower COI (11.7%) and Black/African American race (15.6%).
Conclusions:
- Pediatric OHCA in lower socioeconomic areas and among Black/African American children is linked to worse survival outcomes.
- Reduced bystander cardiopulmonary resuscitation and defibrillator use contribute to these disparities, highlighting a need for targeted community-based interventions.
Objective:
To evaluate the association between Child Opportunity Index (COI) and race and ethnicity and pediatric out-of-hospital cardiac arrest (OHCA) outcomes and the role of bystander response (bystander cardiopulmonary resuscitation and/or defibrillator use) as a mediator.
Methods:
This is a retrospective cohort study using the Cardiac Arrest Registry to Enhance Survival (CARES) of children ≤18 years with OHCA. The exposures are COI quintiles (very low indicates the most disadvantaged neighborhoods) and race and ethnicity. The primary outcome is survival to hospital discharge with favorable neurological outcome (Pediatric Cerebral Performance Category ≤2). Associations of exposures with outcome are determined using logistic regression and mediation analysis is used to evaluate the indirect effect of bystander response.
Results:
Overall, 1654/17,903 (9.2%) had a favorable outcome. Arrests in lower COI neighborhoods and in Black/African American children occurred more frequently in infants and were less likely to be witnessed and to receive bystander response. Arrests in very low COI areas (vs very high COI, adjusted odds ratio aOR 0.68 [95% CI 0.54-0.84], P < 0.001) and Black/African American race (vs White, aOR 0.81 [95% CI 0.69-0.96], P = 0.02) were independently associated with lower odds of a favorable outcome. Lower bystander response partially mediated worse outcomes associated with lower COI quintiles (adjusted percent mediated: 11.7% [95% CI 5.5-17.9], P < 0.001) and Black/African American race (15.6% [95% CI 7.5-23.6], P < 0.001).
Conclusions:
Arrests occurring in lower COI areas and among Black/African American children are associated with lower odds of a favorable outcome. Lower bystander response partially explains these associations.
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