The Association of Structural Inequities and Race With Out-of-Hospital Sudden Death During the COVID-19 Pandemic

Abstract

Background - Social influencers of health (SIOH) namely race, ethnicity and structural inequities are known to affect the incidence of out of hospital sudden death (OHSD). We sought to examine the association between SIOH and the incidence of OHSD in the diverse neighborhoods of New York City (NYC) during the first wave of COVID-19 epidemic. Methods - NYC ZIP stratified data on OHSD were obtained from the Fire Department of New York during the first wave of COVID-19 epidemic (March 1 - April 10, 2019) and the same period in 2020. To assess associates of OHSD, ZIP code-specific sociodemographic characteristics for 8,491,238 NYC residents were obtained via the US Census Bureau's 2018 American Community Survey and the New York Police Department's crime statistics. Results - Between March 1 and April 10, 2020, the number of OHSD rose to 4,334 from 1,112 compared to the year prior. Of the univariate ZIP code level variables evaluated, proportions of: Black race, Hispanic/Latino ethnicity, single parent household, unemployed inhabitants, people completing less than high school education, inhabitants with no health insurance, people financially struggling or living in poverty, percent of non-citizens and population density were associated with increased rates of OHSD within ZIP codes. In multivariable analysis, ZIP codes with higher proportions of inhabitants with less than high school education (p < 0.001) and higher proportions of Black race (p = 0.04) were independent predictors for increases in ZIP code rates of OHSD. Conclusions - Educational attainment and the proportion of Black race in NYC ZIP codes remained independent predictors of increased rates of ZIP code level OHSD during the COVID-19 outbreak even after controlling for 2019 rates. To facilitate health equity, future research should focus on characterizing the impacts of structural inequities while exploring strategies to mitigate their effects.

Comparative Effectiveness of an Automated Text Messaging Service for Monitoring COVID-19 at Home

“…In our study, non-Hispanic Black patients were more likely to be enrolled in COVID Watch than usual care, and Hispanic patients were about as likely to be in either group. White, Black, and Hispanic populations also had significantly reduced mortality when enrolled in COVID Watch, and the overall mortality rates were lower relative to reports nationally ( 28 , 39 , 51 , 52 ). These findings suggest no substantial racial or ethnic barriers to program enrollment or its effectiveness and that implementing this type of remote monitoring service has the potential to reduce racial disparities in regions in which Black and Hispanic patients have decreased access to care and higher mortality rates.…”

Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: Retrospective Cohort Study

“…Self-identified Black patients and those from poorer neighborhoods who contracted SARS-CoV-2 were more likely to be hospitalized and have worse inpatient outcomes when compared to White patients and those from more affluent areas [ 15 , 16 ]. Regarding cardiovascular disease specifically, Black patients have had higher rates of hospitalization from myocardial infarction and greater event rates of sudden cardiac death during the COVID-19 pandemic when compared to prior studies [ 17 , 18 ]. Interestingly though, our study showed a decrease in admissions for non-Hispanic Black patients and no difference in rates of hospitalization for ADHF for other racial and ethnic minority groups.…”

Racial, ethnic, and socioeconomic disparities in out-of-hospital cardiac arrest within the United States: Now is the time for change

“…This reality for minority patients is especially important to consider in the midst of the COVID-19 pandemic, an illness that has impacted minority communities disproportionately and has also caused a rise in the overall incidence of OHCA. 46 To protect these high-risk communities going forward, greater community outreach is necessary, with instructions in bystander CPR and AED usage that are linguistically and culturally appropriate. EMS resuscitation and hospital postresuscitation protocols must also be reviewed, revised, and standardized to ensure efficiency and accuracy.…”