Systematic review and meta-analysis of out-of-hospital cardiac arrest and race or ethnicity: black US populations fare worse

Eur J Prev Cardiol. 2014 May;21(5):619-38. doi: 10.1177/2047487312451815. Epub 2012 Jun 12.


Background: Several studies have reported racial/ethnic variation in out-of-hospital cardiac arrest (OOHCA) characteristics, which engendered varying conclusions. We performed a systematic review and meta-analysed the evidence for differences in OOHCA survival when considering the patient's race and/or ethnicity.

Methods: We searched Medline and EMBASE databases up to and including 1 Oct 2011 for studies investigating racial/ethnic differences in OOHCA characteristics, supplemented by manual searches of bibliographies of relevant studies. We selected studies of any relevant design that measured OOHCA characteristics and stratified them by ethnic group. Two independent reviewers extracted information on the study population, including: race and/or ethnicity, location, age and OOHCA variables as per the Utsein template. We performed a meta-analysis of the studies comparing the black and white patients.

Results: 1701 potentially relevant articles were identified in our systematic search. Of these, 22 articles describing original studies were reviewed after fulfilling our inclusion criteria. Although 19 studies (18 within the United States (US)) compared the black and white population, only 15 fulfilled our quality assessment criteria and were meta-analysed. Compared to white patients, black patients were less likely to receive bystander cardiopulmonary resuscitation (OR = 0.66, 95%CI = 0.55-0.78), have a witnessed arrest (OR = 0.77, 95%CI = 0.72-0.83) or have an initial ventricular fibrillation/ventricular tachycardia arrest rhythm (OR = 0.66, 95%CI = 0.58-0.76). Black patients had lower rates of survival following hospital admission (OR = 0.59, 95%CI = 0.48-0.72) and discharge (OR = 0.74, 95%CI = 0.61-0.90).

Conclusion: Our work highlights the significant discrepancy in OOHCA characteristics and patient survival in relation to the patient's race, with the black population faring less well across all stages. Most studies compared black and white populations within the US, so research elsewhere and with other ethnic groups is needed. This review exposes an inequality that demands urgent action.

Keywords: Ethnicity; Hispanic; South Asian; black population; cardiac care; cardiopulmonary resuscitation; fibrillation; heart attack; minority care; out of hospital cardiac arrest; race; survival; tachycardia; white population.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Black or African American*
  • Cardiopulmonary Resuscitation
  • Chi-Square Distribution
  • Emergency Medical Services
  • Health Services Accessibility
  • Health Status Disparities*
  • Healthcare Disparities / ethnology*
  • Humans
  • Odds Ratio
  • Out-of-Hospital Cardiac Arrest / ethnology*
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / therapy
  • Patient Admission
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States
  • White People