Community disparities in out of hospital cardiac arrest care and outcomes in Texas

Huebinger, Ryan M.; Vithalani, Veer; Osborn, Lesley; Decker, Cameron; Jarvis, Jeff; Dickson, Robert; Escott, Mark E A; White, Lynn J.; Al-Araji, Rabab; Nikonowicz, Peter; Villa, Normandy; Panczyk, Micah; Wang, Henry E.; Bobrow, Bentley J.

doi:10.1016/j.resuscitation.2021.03.021

Cited by 28 publications

(12 citation statements)

References 23 publications

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“…Prior work on, mostly area-level, income disparities and OHCA survival have described the importance to improve of bystander response rates (CPR and/or AED connection) in lower income areas 4 23. Recent work showed that adjusting for SES differences did not mitigate outcome differences in bystander CPR,6 24 which is supported by results from this study.…”

Section: Discussionsupporting

confidence: 78%

Individual-level income and out-of-hospital cardiac arrest survival in men and women

et al. 2022

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ObjectiveArea-level socioeconomic factors are known to associate with chances to survive out-of-hospital cardiac arrest (OHCA survival). However, the relationship between individual-level socioeconomic factors and OHCA survival in men and women is less established. This study investigated the association between individual-level income and OHCA survival in men and women, as well as its contribution to outcome variability and mediation by resuscitation characteristics.MethodsA cross-sectional cohort study using data from a Dutch community-based OHCA registry was performed. We included 5395 patients aged≥25 years with OHCA from a presumed cardiac cause. Household income, derived from Statistics Netherlands, was stratified into quartiles. The association between survival to hospital discharge and household income was analysed using multivariable logistic regression adjusting for age, sex and resuscitation characteristics.ResultsOverall women had lower household income than men (median €18 567 vs €21 015), and less favourable resuscitation characteristics. Increasing household income was associated with increased OHCA survival in both men and women in a linear manner (Q4 vs Q1: OR 1.63 95% CI (1.24 to 2.16) in men, and 2.54 (1.43 to 4.48) in women). Only initial rhythm significantly changed the ORs for OHCA survival with>10% in both men and women. Household income explained 3.8% in men and 4.3% in women of the observed variance in OHCA survival.ConclusionBoth in men and women, higher individual-level household income was associated with a 1.2-fold to 2.5-fold increased OHCA survival to hospital discharge, but explained only little of outcome variability. A shockable initial rhythm was the most important resuscitation parameter mediating this association. Our results do not support the need for immediate targeted interventions on actionable prehospital resuscitation care characteristics.

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Section: Discussionsupporting

confidence: 78%

Individual-level income and out-of-hospital cardiac arrest survival in men and women

et al. 2022

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“…Our findings revealed that urban areas had higher densities of ambulances and physicians than suburb areas. Increasing pre-hospital emergency medical resources could narrow the urban–suburb gap in response time for OHCA, consistent with similar studies ( 31 , 32 ). A well-documented contributor to urban–suburb disparities in EMS response time is the shortage and unequal distribution of resources, especially for regions with large square of areas ( 33 – 35 ).…”

Section: Discussionsupporting

confidence: 88%

Urban–suburb disparities in pre-hospital emergency medical resources and response time among patients with out-of-hospital cardiac arrest: A mixed-method cross-sectional study

Jin

Chen

et al. 2023

Front. Public Health

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AimTo investigate (1) the association between pre-hospital emergency medical resources and pre-hospital emergency medical system (EMS) response time among patients with Out-of-hospital cardiac arrest (OHCA); (2) whether the association differs between urban and suburbs.MethodsDensities of ambulances and physicians were independent variables, respectively. Pre-hospital emergency medical system response time was dependent variable. Multivariate linear regression was used to investigate the roles of ambulance density and physician density in pre-hospital EMS response time. Qualitative data were collected and analyzed to explore reasons for the disparities in pre-hospital resources between urban areas and suburbs.ResultsAmbulance density and physician density were both negatively associated with call to ambulance dispatch time, with odds ratios (ORs) 0.98 (95% confidence interval [CI] 0.96–0.99; P = 0.001) and 0.97 (95% CI; 0.93–0.99; P < 0.001), respectively. ORs of ambulance density and physician density in association with total response time were 0.99 (95% CI: 0.97–0.99; P = 0.013) and 0.90 (95% CI: 0.86–0.99; P = 0.048). The effect of ambulance density on call to ambulance dispatch time in urban areas was 14% smaller than that in suburb areas and that on total response time in urban areas was 3% smaller than the effect in suburbs. Similar effects were identified for physician density on urban–suburb disparities in call to ambulance dispatch time and total response time. The main reasons summarized from stakeholders for a lack of physicians and ambulances in suburbs included low income, poor personal incentive mechanisms, and inequality in financial distribution of the healthcare system.ConclusionImproving pre-hospital emergency medical resources allocation can reduce system delay and narrow urban-suburb disparity in EMS response time for OHCA patients.

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“…A registry-based study across the USA identified that OHCAs in neighbourhoods with predominantly Hispanic residents were less likely to receive BCPR [33]. These findings have been replicated by studies using other OHCA registries in both Texas and Arizona [34,35]. Research using the Danish Cardiac Arrest Registry over a 12-year period found that patients of the lowest socio-economic status by income had the lowest odds of receiving BCPR [36 & ].…”

Section: Early Cprmentioning

confidence: 97%

Health inequities in out-of-hospital cardiac arrest

Boulton

Rios

Perkins

2022

Current Opinion in Critical Care

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Purpose of review Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which a rapid response following the chain of survival is crucial to save life. Disparities in care can occur at each link in this pathway and hence produce health inequities. This review summarises the health inequities that exist for OHCA patients and suggests how they may be addressed. Recent findings There is international evidence that the incidence of OHCA is increased with increasing deprivation and in ethnic minorities. These groups have lower rates of bystander CPR and bystander-initiated defibrillation, which may be due to barriers in accessing cardiopulmonary resuscitation training, provision of public access defibrillators, and language barriers with emergency call handlers. There are also disparities in the ambulance response and in-hospital care following resuscitation. These disadvantaged communities have poorer survival following OHCA. Summary OHCA disproportionately affects deprived communities and ethnic minorities. These groups experience disparities in care throughout the chain of survival and this appears to translate into poorer outcomes. Addressing these inequities will require coordinated action that engages with disadvantaged communities.

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Community disparities in out of hospital cardiac arrest care and outcomes in Texas

Cited by 28 publications

References 23 publications

Individual-level income and out-of-hospital cardiac arrest survival in men and women

Individual-level income and out-of-hospital cardiac arrest survival in men and women

Urban–suburb disparities in pre-hospital emergency medical resources and response time among patients with out-of-hospital cardiac arrest: A mixed-method cross-sectional study

Health inequities in out-of-hospital cardiac arrest

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