Abstract 315: Community Characteristics Associated With Out of Hospital Cardiac Arrest Mortality: The Intersection of Urbanicity, Poverty, and Race

Abstract

Introduction: Variation in survival for out-of-hospital cardiac arrest (OHCA) has been described, but the intersection of urbanicity, race, and poverty and the impact on OHCA outcomes remains unclear. We sought to test whether rurality was associated with increased in-hospital mortality compared to urban and suburban communities when accounting for differences in poverty and race. Methods: We performed a retrospective analysis using 2013-2014 Medicare claims for inpatient stays originating in the emergency department. OHCA Patients (≥65 years) were identified by ICD-9-CM diagnosis code. Urbanicity was assigned based on county of residence using Rural-Urban Continuum Codes. Census data were used for county poverty and racial composition measures. Multivariate logistic regression was used to estimate the association of in-hospital mortality with urbanicity, percent of resident population in poverty, and percent black residency. Also included were individual, hospital, and community characteristics. Results: A total of 246,736 OHCA cases were identified of which 53% were male, 23% non-white, and 36% >75 years. Survival to discharge was 22%. Over 95% of OHCA patients resided in urban (85%) or suburban (11%) areas. Predicted probabilities of death (Figure) were lowest in suburban communities with moderate poverty and small black populations (0.76, CI 0.75-0.76) and highest in urban areas with moderate poverty and larger black populations (0.80, CI 0.80-0.81). All areas with high poverty and larger black populations had similar predicted probabilities (0.77-0.78), regardless of urbanicity. Conclusions: Suburban residence was associated with lower odds of mortality, even in communities with high levels of poverty. Communities with moderate poverty showed the greatest spread of outcomes in all 3 urbanicity categories. Further work should explore access to care, social determinants of health, and hospital factors that lead to the observed disparities.