Association of neighborhood demographics with out-of-hospital cardiac arrest treatment and outcomes

Where you live may matter

Resuscitation Outcomes Consortium (ROC)

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

IMPORTANCE: We examined whether resuscitation care and outcomes vary by the racial composition of the neighborhood where out-of-hospital cardiac arrests (OHCAs) occur. OBJECTIVE: To evaluate the association between bystander treatments (cardiopulmonary resuscitation and automatic external defibrillation) and timing of emergency medical services personnel on OHCA outcomes according to the racial composition of the neighborhood where the OHCA event occurred. DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational cohort study examined patients with OHCA from January 1, 2008, to December 31, 2011, using data from the Resuscitation Outcomes Consortium. Neighborhoods where OHCA occurred were classified by census tract, based on percentage of black residents: less than 25%, 25% to 50%, 51% to 75%, or more than 75%. Multilevel mixed-effects logistic regression modeling examined the association between racial composition of neighborhoods and OHCA survival, adjusting for patient, neighborhood, and treatment characteristics. MAIN OUTCOMES AND MEASURES: Survival to discharge, return of spontaneous circulation on emergency department arrival, and favorable neurologic status at discharge. RESULTS: We examined 22 816 adult patients with nontraumatic OHCA at Resuscitation Outcomes Consortium sites in the United States. The median age of patients with OHCA was 64 years (interquartile range [IQR], 51-78). Compared with patients who experienced OHCA in neighborhoods with a lower proportion of black residents, those in neighborhoods with more than 75% black residents were slightly younger, were more frequently women, had lower rates of initial shockable rhythm, and less frequently experienced OHCA in a public location. The percentage of patients with OHCA receiving bystander cardiopulmonary resuscitation or a lay automatic external defibrillation was inversely associated with the percentage of black residents in neighborhoods. Compared with OHCA in predominantly white neighborhoods (<25% black), those with OHCA in mixed to majority black neighborhoods had lower adjusted survival rates to hospital discharge (25%-50% black: odds ratio, 0.76; 95% CI, 0.61-0.93; 51%-75% black: odds ratio, 0.67; 95% CI, 0.49-0.90; >75% black: odds ratio, 0.63; 95% CI, 0.50-0.79; P < .001). There was similar mortality risk for black and white patients with OHCA in each neighborhood racial quantile. When the primary model included geographic site, there was an attenuated nonsignificant association between racial composition in a neighborhood and survival. CONCLUSIONS AND RELEVANCE: Those with OHCA in predominantly black neighborhoods had the lowest rates of bystander cardiopulmonary resuscitation and automatic external defibrillation use and significantly lower likelihood for survival compared with predominantly white neighborhoods. Improving bystander treatments in these neighborhoods may improve cardiac arrest survival.

Original languageEnglish (US)
Pages (from-to)1110-1118
Number of pages9
JournalJAMA Cardiology
Volume2
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

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Out-of-Hospital Cardiac Arrest
Demography
Cardiopulmonary Resuscitation
Survival
Resuscitation
Emergency Medical Services
Censuses
Heart Arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of neighborhood demographics with out-of-hospital cardiac arrest treatment and outcomes : Where you live may matter. / Resuscitation Outcomes Consortium (ROC).

In: JAMA Cardiology, Vol. 2, No. 10, 01.10.2017, p. 1110-1118.

Research output: Contribution to journalArticle

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abstract = "IMPORTANCE: We examined whether resuscitation care and outcomes vary by the racial composition of the neighborhood where out-of-hospital cardiac arrests (OHCAs) occur. OBJECTIVE: To evaluate the association between bystander treatments (cardiopulmonary resuscitation and automatic external defibrillation) and timing of emergency medical services personnel on OHCA outcomes according to the racial composition of the neighborhood where the OHCA event occurred. DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational cohort study examined patients with OHCA from January 1, 2008, to December 31, 2011, using data from the Resuscitation Outcomes Consortium. Neighborhoods where OHCA occurred were classified by census tract, based on percentage of black residents: less than 25{\%}, 25{\%} to 50{\%}, 51{\%} to 75{\%}, or more than 75{\%}. Multilevel mixed-effects logistic regression modeling examined the association between racial composition of neighborhoods and OHCA survival, adjusting for patient, neighborhood, and treatment characteristics. MAIN OUTCOMES AND MEASURES: Survival to discharge, return of spontaneous circulation on emergency department arrival, and favorable neurologic status at discharge. RESULTS: We examined 22 816 adult patients with nontraumatic OHCA at Resuscitation Outcomes Consortium sites in the United States. The median age of patients with OHCA was 64 years (interquartile range [IQR], 51-78). Compared with patients who experienced OHCA in neighborhoods with a lower proportion of black residents, those in neighborhoods with more than 75{\%} black residents were slightly younger, were more frequently women, had lower rates of initial shockable rhythm, and less frequently experienced OHCA in a public location. The percentage of patients with OHCA receiving bystander cardiopulmonary resuscitation or a lay automatic external defibrillation was inversely associated with the percentage of black residents in neighborhoods. Compared with OHCA in predominantly white neighborhoods (<25{\%} black), those with OHCA in mixed to majority black neighborhoods had lower adjusted survival rates to hospital discharge (25{\%}-50{\%} black: odds ratio, 0.76; 95{\%} CI, 0.61-0.93; 51{\%}-75{\%} black: odds ratio, 0.67; 95{\%} CI, 0.49-0.90; >75{\%} black: odds ratio, 0.63; 95{\%} CI, 0.50-0.79; P < .001). There was similar mortality risk for black and white patients with OHCA in each neighborhood racial quantile. When the primary model included geographic site, there was an attenuated nonsignificant association between racial composition in a neighborhood and survival. CONCLUSIONS AND RELEVANCE: Those with OHCA in predominantly black neighborhoods had the lowest rates of bystander cardiopulmonary resuscitation and automatic external defibrillation use and significantly lower likelihood for survival compared with predominantly white neighborhoods. Improving bystander treatments in these neighborhoods may improve cardiac arrest survival.",
author = "{Resuscitation Outcomes Consortium (ROC)} and Starks, {Monique Anderson} and Schmicker, {Robert H.} and Peterson, {Eric D.} and Susanne May and Buick, {Jason E.} and Kudenchuk, {Peter J.} and Drennan, {Ian R.} and Heather Herren and Jamie Jasti and Michael Sayre and Dion Stub and Vilke, {Gary M.} and Stephens, {Shannon W.} and Chang, {Anna Marie} and Jack Nuttall and Graham Nichol",
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T1 - Association of neighborhood demographics with out-of-hospital cardiac arrest treatment and outcomes

T2 - Where you live may matter

AU - Resuscitation Outcomes Consortium (ROC)

AU - Starks, Monique Anderson

AU - Schmicker, Robert H.

AU - Peterson, Eric D.

AU - May, Susanne

AU - Buick, Jason E.

AU - Kudenchuk, Peter J.

AU - Drennan, Ian R.

AU - Herren, Heather

AU - Jasti, Jamie

AU - Sayre, Michael

AU - Stub, Dion

AU - Vilke, Gary M.

AU - Stephens, Shannon W.

AU - Chang, Anna Marie

AU - Nuttall, Jack

AU - Nichol, Graham

PY - 2017/10/1

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N2 - IMPORTANCE: We examined whether resuscitation care and outcomes vary by the racial composition of the neighborhood where out-of-hospital cardiac arrests (OHCAs) occur. OBJECTIVE: To evaluate the association between bystander treatments (cardiopulmonary resuscitation and automatic external defibrillation) and timing of emergency medical services personnel on OHCA outcomes according to the racial composition of the neighborhood where the OHCA event occurred. DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational cohort study examined patients with OHCA from January 1, 2008, to December 31, 2011, using data from the Resuscitation Outcomes Consortium. Neighborhoods where OHCA occurred were classified by census tract, based on percentage of black residents: less than 25%, 25% to 50%, 51% to 75%, or more than 75%. Multilevel mixed-effects logistic regression modeling examined the association between racial composition of neighborhoods and OHCA survival, adjusting for patient, neighborhood, and treatment characteristics. MAIN OUTCOMES AND MEASURES: Survival to discharge, return of spontaneous circulation on emergency department arrival, and favorable neurologic status at discharge. RESULTS: We examined 22 816 adult patients with nontraumatic OHCA at Resuscitation Outcomes Consortium sites in the United States. The median age of patients with OHCA was 64 years (interquartile range [IQR], 51-78). Compared with patients who experienced OHCA in neighborhoods with a lower proportion of black residents, those in neighborhoods with more than 75% black residents were slightly younger, were more frequently women, had lower rates of initial shockable rhythm, and less frequently experienced OHCA in a public location. The percentage of patients with OHCA receiving bystander cardiopulmonary resuscitation or a lay automatic external defibrillation was inversely associated with the percentage of black residents in neighborhoods. Compared with OHCA in predominantly white neighborhoods (<25% black), those with OHCA in mixed to majority black neighborhoods had lower adjusted survival rates to hospital discharge (25%-50% black: odds ratio, 0.76; 95% CI, 0.61-0.93; 51%-75% black: odds ratio, 0.67; 95% CI, 0.49-0.90; >75% black: odds ratio, 0.63; 95% CI, 0.50-0.79; P < .001). There was similar mortality risk for black and white patients with OHCA in each neighborhood racial quantile. When the primary model included geographic site, there was an attenuated nonsignificant association between racial composition in a neighborhood and survival. CONCLUSIONS AND RELEVANCE: Those with OHCA in predominantly black neighborhoods had the lowest rates of bystander cardiopulmonary resuscitation and automatic external defibrillation use and significantly lower likelihood for survival compared with predominantly white neighborhoods. Improving bystander treatments in these neighborhoods may improve cardiac arrest survival.

AB - IMPORTANCE: We examined whether resuscitation care and outcomes vary by the racial composition of the neighborhood where out-of-hospital cardiac arrests (OHCAs) occur. OBJECTIVE: To evaluate the association between bystander treatments (cardiopulmonary resuscitation and automatic external defibrillation) and timing of emergency medical services personnel on OHCA outcomes according to the racial composition of the neighborhood where the OHCA event occurred. DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational cohort study examined patients with OHCA from January 1, 2008, to December 31, 2011, using data from the Resuscitation Outcomes Consortium. Neighborhoods where OHCA occurred were classified by census tract, based on percentage of black residents: less than 25%, 25% to 50%, 51% to 75%, or more than 75%. Multilevel mixed-effects logistic regression modeling examined the association between racial composition of neighborhoods and OHCA survival, adjusting for patient, neighborhood, and treatment characteristics. MAIN OUTCOMES AND MEASURES: Survival to discharge, return of spontaneous circulation on emergency department arrival, and favorable neurologic status at discharge. RESULTS: We examined 22 816 adult patients with nontraumatic OHCA at Resuscitation Outcomes Consortium sites in the United States. The median age of patients with OHCA was 64 years (interquartile range [IQR], 51-78). Compared with patients who experienced OHCA in neighborhoods with a lower proportion of black residents, those in neighborhoods with more than 75% black residents were slightly younger, were more frequently women, had lower rates of initial shockable rhythm, and less frequently experienced OHCA in a public location. The percentage of patients with OHCA receiving bystander cardiopulmonary resuscitation or a lay automatic external defibrillation was inversely associated with the percentage of black residents in neighborhoods. Compared with OHCA in predominantly white neighborhoods (<25% black), those with OHCA in mixed to majority black neighborhoods had lower adjusted survival rates to hospital discharge (25%-50% black: odds ratio, 0.76; 95% CI, 0.61-0.93; 51%-75% black: odds ratio, 0.67; 95% CI, 0.49-0.90; >75% black: odds ratio, 0.63; 95% CI, 0.50-0.79; P < .001). There was similar mortality risk for black and white patients with OHCA in each neighborhood racial quantile. When the primary model included geographic site, there was an attenuated nonsignificant association between racial composition in a neighborhood and survival. CONCLUSIONS AND RELEVANCE: Those with OHCA in predominantly black neighborhoods had the lowest rates of bystander cardiopulmonary resuscitation and automatic external defibrillation use and significantly lower likelihood for survival compared with predominantly white neighborhoods. Improving bystander treatments in these neighborhoods may improve cardiac arrest survival.

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