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

Abstract

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.

Development of an accessible CPR device to improve outcomes for Out-of-hospital Cardiac Arrest

“…In a Texas study published in 2020, results revealed that the Black community has experienced the worst survival rates; cardiac arrest incidences are normally higher in Black communities, but AED use was an abysmal 3.2% compared to 11.2% in white neighborhoods. While the Latino communities had a 4.9% of AED use, there was a significantly lower rate of CPR administration of 38% compared to that of white neighborhoods at 47.5% (Huebinger, 2020). Socioeconomic barriers were also a strong determinant of the quality of care received after an OHCA.…”

“…Socioeconomic barriers were also a strong determinant of the quality of care received after an OHCA. Lower income areas have an 8.4% of AED use compared to high income areas that have a 11.9% use of AEDs (Huebinger, 2020). In low SES areas, access to AEDs are also limited because the devices are cost prohibitive and need extensive training for effective use.…”