Socioeconomic status and post-arrest care after out-of-hospital cardiac arrest in Texas

Disentangling the Complex Web of Out-of-Hospital Cardiac Arrest Socioeconomic Disparities

“…Less than one-half of patients with OHCA in the medical aid group survived with good neurological recovery in comparison with the highest SEP group (first quartile). Interestingly though, outcome rates were similar between the 4 higher SEP groups (first through fourth quartiles).These findings somewhat differ from other studies of SEP, 4,5 where there is a more consistent linear association between SEP and survival outcomes. Witnessed arrest, bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, sustained return of spontaneous circulation, emergency department (ED) level of care, coronary angiography, and targeted temperature management (TTM) were all identified as mediators between lower SEP and poorer OHCA outcomes.In their attempt to quantify mediation proportion, they found that witness status (11.8%), initial rhythm (56.2%), coronary angiography (20.2%), TTM (4.2%), and ED level of care (10.7%) to have the largest independent mediation proportions among patients who survived to hospital admission.These findings shed important light on modifiable factors amenable to public health interventions to mitigate disparities in OHCA outcomes.…”

“…Insurance status was also associated with differences in TTM and coronary angiography, similar to our findings in Texas. 5 Because the Korean emergency medical system is tax-financed and free of charge for all patients, post−cardiac arrest care might be more susceptible to disparities related to insurance status with insurance providers having more time to evaluate compensation potential.…”

Higher socioeconomic status is associated with lower in-hospital cardiac arrest: How can we address this socioeconomic inequality?

“…Numerous studies have established the role of socioeconomic status (SES) in explaining observed inequalities in incidence of cardiac arrest, receipt of care (e.g. bystander cardiopulmonary resuscitation [CPR], targeted temperature management, percutaneous coronary intervention), [1][2][3] and outcomes in cardiac arrest. [4][5][6] These studies, however, predominantly focus on out-ofhospital cardiac arrest (OHCA) patients.…”

Community-level socioeconomic status and the role of the hospital: Does where you have an arrest affect receipt of post-arrest care?

“…In their most recent article, Huebinger et al described the effect of SES on receipt of post-arrest care defined as receipt of percutaneous coronary intervention [PCI] and targeted temperature management [TTM]. 8 Using the Cardiac Arrest Registry to Enhance Survival (CARES) from Texas (2014-2020, n = 9,936), the team found that poor community-level income, education, and employment were all associated with lower receipt of PCI and TTM. They further found that these differences were substantially attenuated after adjusting for hospital sites, suggesting that the effect of SES was mediated through care delivery patterns at different hospitals.…”

“…They further found that these differences were substantially attenuated after adjusting for hospital sites, suggesting that the effect of SES was mediated through care delivery patterns at different hospitals. 8 There were several limitations to the study including the measures used to quantify SES and post-arrest care. Despite this, these findings are an important addition to the existing literature, which thus far has focused heavily on examining the impact of community-level SES on delivery of bystander interventions and prehospital care.…”