Survival After Out-of-Hospital Cardiac Arrest: The Role of Racial Residential Segregation

Abbott, Ethan; Buckler, David G; Hsu, Jesse Y.; Jacoby, Sara F.; Abella, Benjamin S.; Richardson, Lynne D.; Carr, Brendan G.; Zebrowski, Alexis

doi:10.1007/s11524-022-00691-x

Cited by 7 publications

(7 citation statements)

References 39 publications

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“…This methodology has been previously applied in our research exploring both short and long-term outcomes in OHCA. 13, 14 The ICE measure is considered a more methodologically robust method as compared with other measures such as the usage of racial of ethnic percentage composition of a given geographic area (census tract, county, ZIP code). ICE captures geographies where extreme differences in race, ethnicity, and economic segregation exist—factors that are potential drivers of disparities in health outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…3,[10][11][12] In our prior OHCA research, we found that measures of racial and economic segregation are predictors of disparities in outcomes; Medicare beneficiaries residing in more highly segregated Black population and lower income ZIP codes had decreased likelihood of survival to discharge and survival at one year, as well as increased risk of readmission at 30 days. 13,14 However, prehospital predictors are not available in claims data, such as initial rhythm or the presence of a bystander CPR (B-CPR). To better understand the association of measures of residential segregation with OHCA clinical outcomes while accounting for important prehospital variables, we utilized Cardiac Arrest Registry to Enhance Survival (CARES) dataset to examine if there are differences in survival to discharge and survival with good neurological outcome, as well as likelihood of bystander CPR, using validated measures of racial, ethnic, and economic segregation.…”

Section: Introductionmentioning

confidence: 99%

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The Association of Racial Residential Segregation and Survival After Out-of-Hospital Cardiac Arrest in the United States

Abbott,

Buckler,

Shekhar

et al. 2024

Preprint

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Background Residential segregation has been identified as drivers of disparities in health outcomes, but further work is needed to understand this association with clinical outcomes for out-of-hospital cardiac arrest (OHCA). We utilized Cardiac Arrest Registry to Enhance Survival (CARES) dataset to examine if there are differences in survival to discharge and survival with good neurological outcome, as well as likelihood of bystander CPR, using validated measures of racial, ethnic, and economic segregation. Methods We conducted a retrospective observational study using data from the Cardiac Arrest Registry to Enhance Survival (CARES) dataset to examine associations among adult OHCA patients. The primary predictor was the Index of Concentration at the Extremes (ICE), a validated measure that includes race, ethnicity, and income across three measures at the census tract level. The primary outcomes were survival to discharge and survival with good neurological status. A multivariable modified Poisson regression modeling approach with random effects at the EMS agency and hospital level was utilized. Results We identified 626,264 OHCA patients during the study period. The mean age was 62 years old (SD 17.2 years), and 35.7% (n =223,839) of the patients were female. In multivariable models, we observed an increased likelihood of survival to discharge and survival with good neurological outcome for those patients residing in predominately White population census tracts and higher income census tracts as compared to lower income Black and Hispanic/Latinx population census tracts (RR 1.24, CI 1.20-1.28) and a 32% increased likelihood of receiving bystander CPR in higher income census tracts as compared to reference (RR 1.32, CI 1.30-1.34). Conclusions In this study examining the association of measures of residential segregation and OHCA outcomes, there was an increased likelihood of survival to discharge, survival with good neurological status, and likelihood of receiving B-CPR for those patients residing in predominately White population and higher income census tracts when compared to predominately Black and/or Hispanic Latinx populations and lower income census tracts. This research suggests that areas impacted by residential and economic segregation are important targets for both public policy interventions as well as addressing disparities in care across the chain of survival for OHCA.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association of Racial Residential Segregation and Survival After Out-of-Hospital Cardiac Arrest in the United States

Abbott,

Buckler,

Shekhar

et al. 2024

Preprint

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“…This approach has been refined and adapted by Krieger and colleagues and used in our prior research examining short‐term OHCA outcomes. 19 , 23 , 24 Krieger and colleagues demonstrated that measures of racialized economic segregation are more robust at identifying associations with poor health outcomes and avoiding potential methodological issues encountered using other approaches. 17 , 23 , 24 , 25 …”

Section: Methodsmentioning

confidence: 99%

“…Our prior work examining the association between measures of racial and economic residential segregation and survival to discharge after OHCA demonstrated a lower likelihood of survival to discharge among Medicare beneficiaries residing in predominately Black communities and lower‐income ZIP codes compared with White communities and higher‐income ZIP codes. 19 The mechanisms by which residential segregation influences health outcomes are complex and multifactorial but likely impact quality and access to health care, and they are also spread across other social domains within each specific community. OHCA survivors residing in disadvantaged areas experience amplified disparities attributable to the structural and community effects of segregation that affect health and social resources along their continuum of care and likely impact risk for hospital readmission.…”

mentioning

confidence: 99%

Association of Racial Residential Segregation With Long‐Term Outcomes and Readmissions After Out‐of‐Hospital Cardiac Arrest Among Medicare Beneficiaries

Abbott,

Buckler,

Hsu

et al. 2023

JAHA

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Background The national impact of racial residential segregation on out‐of‐hospital cardiac arrest outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long‐term survival and readmissions after out‐of‐hospital cardiac arrest among Medicare beneficiaries. Methods and Results In this retrospective cohort study, using Medicare claims data, our primary predictor was the index of concentration at the extremes, a measure of racial and economic segregation. The primary outcomes were death up to 3 years and readmissions. We estimated hazard ratios (HRs) across all 3 types of index of concentration at the extremes measures for each outcome while adjusting for beneficiary demographics, treating hospital characteristics, and index hospital procedures. In fully adjusted models for long‐term survival, we found a decreased hazard of death and risk of readmission for beneficiaries residing in the more segregated White communities and higher‐income ZIP codes compared with the more segregated Black communities and lower‐income ZIP codes across all 3 indices of concentration at the extremes measures (race: HR, 0.87 [95% CI, 0.81–0.93]; income: HR, 0.75 [95% CI, 0.69–0.78]; and race+income: HR, 0.77 [95% CI, 0.72–0.82]). Conclusions We found a decreased hazard of death and risk for readmission for those residing in the more segregated White communities and higher‐income ZIP codes compared with the more segregated Black communities and lower‐income ZIP codes when using validated measures of racial and economic segregation. Although causal pathways and mechanisms remain unclear, disparities in outcomes after out‐of‐hospital cardiac arrest are associated with the structural components of race and wealth and persist up to 3 years after discharge.

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“…[13][14][15][16][17] Our prior work examining the association between measures of racial and economic residential segregation and survival to discharge after OHCA demonstrated a lower likelihood of survival to discharge among Medicare beneficiaries residing in predominately Black and lower income ZIP codes as compared to White and higher income ZIP codes. 18 The mechanisms of residential segregation on health outcomes are complex and multifactorial but are likely to impact quality and access to healthcare, and are also spread across other social domains within each community. OHCA survivors residing in disadvantaged areas likely experience amplified disparities due to the structural and community effects of segregation that affect health and social resources along their continuum of care.…”

Section: Introductionmentioning

confidence: 99%

The Association of Racial Residential Segregation and Long-Term Outcomes after Out-Of-Hospital Cardiac Arrest Among Medicare Beneficiaries

Abbott

Buckler

Hsu

et al. 2022

Preprint

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Background Racial residential segregation in the US is associated with poor health outcomes across multiple chronic conditions including cardiovascular disease. However, the national impact of racial residential segregation on out-of-hospital cardiac arrest (OHCA) outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long-term survival after OHCA among Medicare beneficiaries. Methods In this retrospective cohort study, utilizing Medicare fee-for-service claims data from 2013-2015, our primary predictor was the index of concentration at the extremes (ICE), a measure of racial and economic segregation. The primary outcomes were death at 1 and 3 years. Using random-effects Cox proportional hazards models, including a shared frailty term to account for clustering at the hospital level, we estimated hazard ratios across all three types of ICE measures for each outcome while adjusting for beneficiary demographics, treating hospital characteristics, and index hospital procedures. Results We identified 29,847 OHCA claims for beneficiaries who survived to discharge after an OHCA. Mean beneficiary age was 75 years (SD 8); 40.1% were female, 80% White and 15.2% Black. Overall crude survival for the cohort was 54% (n=16,129) at 1 year and 40.8% (n= 12,189) at 3 years. In fully adjusted models we found a decreased hazard of death in beneficiaries residing in the most racially and economically privileged ZIP codes (Q5) compared to the least privileged areas (Q1) across all three ICE measures (race: HR:0.84; CI 0.79-0.88, income: HR 0.76; CI 0.73-0.81, race + income: HR 0.78; CI 0.74-0.83) Conclusion We found a decreased hazard of death for those residing in predominately White and higher income ZIP codes as compared to majority Black and lower income ZIP codes when using validated measures of racial and economic segregation. Future work will need to more closely examine the causal pathways and mechanisms related to disparities in outcomes after OHCA to better understand the impacts of spatial and living environments on long-term outcomes.

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Survival After Out-of-Hospital Cardiac Arrest: The Role of Racial Residential Segregation

Cited by 7 publications

References 39 publications

The Association of Racial Residential Segregation and Survival After Out-of-Hospital Cardiac Arrest in the United States

The Association of Racial Residential Segregation and Survival After Out-of-Hospital Cardiac Arrest in the United States

Association of Racial Residential Segregation With Long‐Term Outcomes and Readmissions After Out‐of‐Hospital Cardiac Arrest Among Medicare Beneficiaries

The Association of Racial Residential Segregation and Long-Term Outcomes after Out-Of-Hospital Cardiac Arrest Among Medicare Beneficiaries

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