Abstract 262: Race/ethnicity Is Associated With Mortality After Pediatric Cardiopulmonary Resuscitation: An Analysis Of The KIDs’ Inpatient Database

Abstract

Introduction: Survival disparities in adult in-hospital cardiac arrest (IHCA) are well-described with decreased survival in Black patients. Pediatric literature from AHA’s GWTG—Resuscitation did not show this association, possibly due to differences in IHCA definitions and patient population. We aimed to investigate associations between outcomes after pediatric CPR and race/ethnicity and insurance payer status in a nationally representative database. We hypothesized non-White race/ethnicity, compared to white race, and public insurance, compared to private insurance, would be associated with lower rates of survival. Methods: Retrospective cohort study of subjects ≤18 years with CPR procedure codes in the 1997- 2019 editions of the Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID). We excluded subjects missing race/ethnicity, insurance payer or disposition and subjects with in-patient transfer as their disposition. We evaluated hypothesized associations with weighted mixed-effect logistic regression clustered by hospital. Hospital (size, teaching/non-teaching institution, rural/urban, region) and patient (age, KID cohort year, sex, insurance payer, complex chronic condition, median income quartile) confounders were considered fixed effects. Individual hospitals were treated as a random effect. Results: Our cohort included 27,332 children admitted to 3,353 centers. Univariable and multivariable modeling showed higher odds of in-hospital mortality for all non-White categories compared to white race: Black (aOR 1.20, 95% CI 1.08-1.34; p<0.001), Hispanic (aOR 1.17, 95%CI 1.05-1.31; p=0.006), and other race/ethnicity (aOR 1.37, 95%CI 1.20-1.57; p<0.001). There was no difference in mortality between those with public and private insurance. Conclusions: In contrast to previously published data, after risk- and reliability-adjustment of individual and hospital-level effects, children receiving CPR with non-White race/ethnicity had higher mortality odds. These findings suggest the presence of race/ethnicity-based disparities in pediatric IHCA mortality, the mechanisms of which should be explored.