Persistent Racial/Ethnic Disparities in Out-of-Hospital Cardiac Arrest

Introduction: Variation exists in outcomes following out-of-hospital cardiac arrest (OHCA), but whether racial/ethnic disparities exist in post-arrest provision of therapeutic hypothermia (TH) is unknown. Hypothesis: Racial/ethnic disparities exist in the utilization of guideline-recommended TH following OHCA. Methods: We performed a retrospective analysis of a cohort of 96,695 patients who survived to hospital admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~40% of the United States, from 2013 through 2019. Our primary exposure was race/ethnicity, and the primary outcome was utilization of TH. We performed a secondary analysis to assess for racial/ethnic disparities in the reasons why TH was not used (supplemental data element data available since 2016). Results: Among 96,695 patients [mean (SD) age 61.4 (16.3) years, 24.6% Black, 8.0% Hispanic/Latino, 63.4% White] that survived to hospital admission following OHCA, 54,687 (56.6%) did not receive TH. Using a mixed-effects model that adjusted for patient, arrest, neighborhood, and hospital factors with state of arrest modeled as a random intercept to account for clustering, we found that Hispanics/Latinos were less likely to receive TH than Whites (Odds Ratio [OR] 0.79, 95 % Confidence Interval [CI] 0.75-0.83). When the clustering variable was changed from the state of arrest to the admitting hospital, Hispanics/Latinos were more likely to receive TH (OR 1.07, 95% CI 1.00 to 1.14). In the 22,896 patients with data regarding why they did not receive TH, a higher percentage of Hispanics/Latinos compared to Blacks and Whites did not receive TH due to lack of a TH program at the hospital (4.0% vs. 2.5 % vs 1.8%, p < .001). No disparity in TH utilization was found for Black patients. Conclusion: We found disparities in access to TH for Hispanics/Latinos following OHCA. Reassuringly, we did not find any disparity in TH utilization for Black patients.

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GENDER AND RACIAL/ETHNIC DIFFERENCES IN SURVIVAL AFTER CARDIOPULMONARY RESUSCITATION FOR IN-HOSPITAL CARDIAC ARREST

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)60341-7 ◽

2014 ◽

Vol 63 (12) ◽

pp. A341 ◽

Cited By ~ 1

Author(s):

Dhaval Kolte ◽

Sahil Khera ◽

Wilbert Aronow ◽

Marjan Mujib ◽

Chandrasekar Palaniswamy ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Ethnic Differences ◽

Racial Ethnic ◽

Hospital Cardiac Arrest

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Abstract 13150: Racial/Ethnic Disparities of the Impact of the COVID-19 Pandemic Out-of-Hospital Cardiac Arrest (OHCA) in Texas

Circulation ◽

10.1161/circ.144.suppl_2.13150 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Summer Chavez ◽

Ryan Huebinger ◽

Kevin Schulz ◽

Hei Kit Chan ◽

Micah Panczyk ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Admission ◽

Minority Groups ◽

Ethnic Disparities ◽

Mixed Effect ◽

Neurological Outcomes ◽

Random Intercept ◽

Hispanic Patients ◽

The Impact ◽

Racial Ethnic

Introduction: Prior research shows a greater disease burden, lower BCPR rates, and worse outcomes in Black and Hispanic patients after OHCA. The CDC has declared that the COVID-19 pandemic has disproportionately affected many racial and ethnic minority groups. However, the influence of the COVID-19 pandemic on OHCA incidence and outcomes in different races and ethnicities is unknown. Purpose: To describe racial/ethnic disparities in OHCA incidence, processes of care and outcomes in Texas during the COVID-19 pandemic. Methods: We used data from the Texas Cardiac Arrest Registry to Enhance Survival (CARES) comparing adult OHCA from the pre-pandemic period (March 11 - December 31, 2019) to the pandemic period (March 11- December 31, 2020). The racial and ethnic categories were White, Black, Hispanic or Other. Outcomes were rates of BCPR, AED use, sustained ROSC, prehospital termination of resuscitation (TOR), survival to hospital admission, survival to discharge and good neurological outcomes. We fit a mixed effect logistic regression model, with EMS agency designated as the random intercept to obtain aORs. We adjusted for the pandemic and other covariates. Results: A total of 8,070 OHCAs were included. The proportion of cardiac arrests increased for Blacks (903 to 1, 113, 24.9% to 25.5%) and Hispanics (935 to 1,221, 25.8% to 27.5%) and decreased for Whites (1 595 to 1,869, 44.0% to 42.1%) and Other (194 to 220, 5.4% to 5.0%) patients. Compared to Whites, Black (aOR = 0.73, 95% CI 0.65-0.82) and Hispanic patients (aOR = 0.78, 95% CI 0.68-0.87) were less likely to receive BCPR. Compared to Whites, Blacks were less likely to have sustained ROSC (aOR = 0.81, 95% CI 0.70-0.93%), with lower rates of survival to hospital admission (aOR = 0.87, 95% CI 0.75-1.0), and worse neurological outcomes (aOR = 0.45, 95% 0.28-0.73). Hispanics were less likely to have prehospital TOR compared to Whites (aOR = 0.86, 95% CI = 0.75-0.99). The Utstein bystander survival rate was worse for Blacks (aOR = 0.72, 95% CI 0.54-0.97) and Hispanics (aOR = 0.71, 95% 0.53-0.95) compared to Whites. Conclusion: Racial and ethnic disparities persisted during the COVID-19 pandemic in Texas.

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Ethnic disparities in the incidence and outcome from out-of-hospital cardiac arrest: A New Zealand observational study

Resuscitation ◽

10.1016/j.resuscitation.2019.09.026 ◽

2019 ◽

Vol 145 ◽

pp. 56-62 ◽

Cited By ~ 1

Author(s):

Bridget Dicker ◽

Verity F. Todd ◽

Bronwyn Tunnage ◽

Andy Swain ◽

Kate Conaglen ◽

...

Keyword(s):

Cardiac Arrest ◽

New Zealand ◽

Observational Study ◽

Ethnic Disparities ◽

Hospital Cardiac Arrest

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Out-of-Hospital Cardiac Arrest Registry Highlights Ethnic Disparities in NZ

Heart Lung and Circulation ◽

10.1016/j.hlc.2019.05.151 ◽

2019 ◽

Vol 28 ◽

pp. S59

Author(s):

Verity Todd ◽

Bridget Dicker ◽

Kate Conaglen ◽

Bronwyn Tunnage ◽

Tony Smith ◽

...

Keyword(s):

Cardiac Arrest ◽

Ethnic Disparities ◽

Hospital Cardiac Arrest

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Hispanic/Latino‐Serving Hospitals Provide Less Targeted Temperature Management Following Out‐of‐Hospital Cardiac Arrest

Journal of the American Heart Association ◽

10.1161/jaha.121.023934 ◽

2021 ◽

Author(s):

Nicholas A. Morris ◽

Michael Mazzeffi ◽

Patrick McArdle ◽

Teresa L. May ◽

Greer Waldrop ◽

...

Keyword(s):

Cardiac Arrest ◽

Ethnic Disparities ◽

The United States ◽

Mixed Effects ◽

Mixed Effects Model ◽

Targeted Temperature Management ◽

Community Level ◽

Temperature Management ◽

Hospital Cardiac Arrest ◽

White Patients

Abstract Background Variation exists in outcomes following out‐of‐hospital cardiac arrest (OHCA), but whether racial and ethnic disparities exist in post‐arrest provision of targeted temperature management (TTM) is unknown. Methods and Results We performed a retrospective analysis of a prospectively collected cohort of patients who survived to admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~50% of the United States from 2013‐2019. Our primary exposure was race/ethnicity and primary outcome was utilization of TTM. We built a mixed‐effects model with both state of arrest and admitting hospital modeled as random intercepts to account for clustering. Among 96,695 patients (24.6% Black, 8.0% Hispanic/Latino, 63.4% White), a smaller percentage of Hispanic/Latino patients received TTM than Black or White patients (37.5% vs. 45.0 % vs 43.3%, P < .001) following OHCA. In the mixed‐effects model, Black patients (Odds Ratio [OR] 1.153, 95% Confidence Interval [CI] 1.102‐1.207, P < .001) and Hispanic/Latino patients (OR 1.086, 95% CI 1.017‐1.159, P < .001) were slightly more likely to receive TTM compared to White patients, perhaps due to worse admission neurological status. We did find community level disparity as Hispanic/Latino‐serving hospitals (defined as the top decile of hospitals that cared for the highest proportion of Hispanic/Latino patients) provided less TTM (OR 0.587, 95% CI 0.474 to 0.742, P < .001). Conclusions Reassuringly, we did not find evidence of intrahospital or interpersonal racial or ethnic disparity in the provision of TTM. However, we did find inter‐hospital, community level disparity. Hispanic/Latino‐serving hospitals provided less guideline‐recommended TTM after OHCA.

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Abstract 136: Disparities in Out of Hospital Cardiac Arrest Care and Outcomes in Texas

Circulation ◽

10.1161/circ.142.suppl_4.136 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Ryan Huebinger ◽

Henry Wang ◽

Jeff Jarvis ◽

Cameron Decker ◽

Robert Dickson ◽

...

Keyword(s):

High School ◽

Cardiac Arrest ◽

Hospital Discharge ◽

Census Tract ◽

High School Graduation ◽

Census Tracts ◽

Bystander Cpr ◽

School Graduation ◽

Racial Ethnic ◽

Hospital Cardiac Arrest

Background: Minorities and impoverished persons experience disparities in access to healthcare. Large inequalities in out-of-hospital cardiac arrest (OHCA) care have been described. We sought to characterize racial and socioeconomic disparities in OHCA care and outcomes in Texas. Hypothesis: There are census tract level disparities in OHCA care and outcomes in Texas. Methods: We analyzed Texas-Cardiac Arrest Registry to Enhance Survival (CARES) data from 13 EMS agencies providing care in 15 counties to roughly 30% of the state population. We included all adult (>=18 year) OHCA from 1/1/14 through 12/31/18 with complete data. Using census tract data, we stratified census tracts into racial/ethnic categories: >50% non-Hispanic/Latino white, >50% black, and >50% Hispanic/Latino. We also stratified census tracts into neighborhoods above and below the median for socioeconomic characteristics: household income, employment rate, and high school graduation. We defined outcomes as bystander CPR rates, public bystander AED use, and survival to hospital discharge. Using mixed models, we analyzed the associations between outcomes and neighborhood (1) racial/ethnic categories and (2) socioeconomic categories. Results: We included data on 18,487 OHCAs from 1,727 census tracts. Relative to white neighborhoods, black neighborhoods had a significantly lower rate of bystander AED use (OR 0.3, CI 0.1-0.9), and Latino neighborhoods had a lower rate of bystander CPR (OR 0.7, CI 0.6-0.8), bystander AED use (OR 0.4, CI 0.3-0.6) and survival to hospital discharge (OR 0.9, CI 0.8-0.98). Lower income was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.8), bystander AED use (OR 0.5, 0.4-0.8), and survival to hospital discharge (OR 0.6, CI 0.5-0.9). Lower high school graduation was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.9) and bystander AED use (OR 0.6, CI 0.4-0.9). High unemployment was associated with lower rates of bystander CPR (OR 0.9, CI 0.8-0.94) and bystander AED use (OR 0.7, CI 0.5-0.99). Conclusion: Minority and poor neighborhoods in Texas experience large and unacceptable disparities in OHCA bystander response and outcomes. These data present an important opportunity for targeted resuscitation training and quality improvement.

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Incidence of out of hospital cardiac arrest with ethnic disparities in the Wellington region

Heart Lung and Circulation ◽

10.1016/j.hlc.2015.04.118 ◽

2015 ◽

Vol 24 ◽

pp. S97

Author(s):

M. Wolbinski ◽

A. Swain ◽

M. Webber ◽

S. Harding ◽

P. Larsen

Keyword(s):

Cardiac Arrest ◽

Ethnic Disparities ◽

Hospital Cardiac Arrest

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Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter?

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab079 ◽

2021 ◽

Author(s):

Jens Agerström ◽

Magnus Carlsson ◽

Anders Bremer ◽

Johan Herlitz ◽

Araz Rawshani ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Middle Eastern ◽

Ethnic Disparities ◽

Great Majority ◽

Heart Rhythm ◽

Hospital Staff ◽

Registry Study ◽

The Impact ◽

Hospital Cardiac Arrest

Abstract Aims Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context. Methods and results In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team’s reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52). Conclusion Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

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Study finds racial/ethnic disparities in depressive trajectories among middle-aged or older adults

PsycEXTRA Dataset ◽

10.1037/e531082012-003 ◽

2012 ◽

Author(s):

J. Liang ◽

X. Xu ◽

A. R. Quinones ◽

J. M. Bennett ◽

W. Ye

Keyword(s):

Older Adults ◽

Ethnic Disparities ◽

Middle Aged ◽

Racial Ethnic

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