Abstract 16091: Racial and Socioeconomic Predictors of Out of Hospital Cardiac Arrest Mortality
Background: Prior studies have demonstrated that African-Americans (AA) have higher rates of out of hospital cardiac arrest (OHCA) and worse survival than Caucasians (W). The short-term survival of other racial groups relative to W, and the effects of income and insurance have not been examined.
Methods: Using Healthcare Cost and Utilization Project data, which captures >95% of adult California hospitalizations, we identified patients receiving emergency department (ED) or inpatient care between 1/1/2005 and 12/31/2009. OHCA was defined by victims transported to the ED for VF (ICD-9 427.4) or cardiac arrest (427.5); inpatient arrests and cases of primary trauma and sepsis were excluded. Survival rates to hospital discharge were evaluated. Multivariate regression models were used to evaluate the effects of race, income, and insurance on survival adjusting for age, gender, comorbidities, median income, hospital location, and length of stay.
Results: Of 118,281 OHCA admissions, 30,128 (25%) survived to hospital discharge. Survivors were more likely to be younger, male, and have fewer comorbidities. Unadjusted and adjusted survival rates were lower in AA (23%), Hispanics (25%), and Asians (26%) compared to W (27%), adjusted OR 0.79, 0.84, 0.83, respectively; p<0.001 for all Compared to Medicare, Medicaid recipients had lower odds and the privately insured had higher odds of survival (adjusted OR 0.72, 95% CI 0.68-0.77, p<0.001; and OR 1.53, 95% CI 1.46-1.61, p<0.001). Patients with the highest quartile of income had greater odds of survival than those with the lowest quartile (adjusted OR 1.33, 95% CI 1.26-1.41, p<0.001). Compared to W, all other racial groups were less likely to receive diagnostic angiography after OHCA; AA had half the odds of W (adjusted OR 0.51, CI 0.45-0.56, p<0.001).
Conclusions: AA, Hispanic, and Asian OHCA victims each have lower rates of survival to discharge than W victims. Poorer patients and those without private insurance had lower survival rates. These findings may be explained by differences in resuscitation efforts, hospital characteristics, or other unmeasured factors. Additionally, all non-W groups had lower odds of receiving angiography, suggesting differential hospital care between groups.
- © 2013 by American Heart Association, Inc.