Racial and ethnic differences in outcomes after out-of-hospital cardiac arrest: Hispanics and Blacks may fare worse than non-Hispanic Whites

Resuscitation. 2019 Apr;137:29-34. doi: 10.1016/j.resuscitation.2019.01.038. Epub 2019 Feb 10.

Abstract

Background: This study evaluates differences in out-of-hospital cardiac arrest (OHCA) characteristics, interventions, and outcomes by race/ethnicity.

Methods: This is a retrospective analysis from a regionalized cardiac system. Outcomes for all adult patients treated for OHCA with return of spontaneous circulation (ROSC) were identified from 2011-2014. Stratifying by race/ethnicity with White as the reference group, patient characteristics, treatment, and outcomes were evaluated. The adjusted odds ratios (OR) for survival with good neurologic outcome (cerebral performance category 1 or 2) were calculated.

Results: There were 5178 patients with OHCA; 290 patients excluded for unknown race, leaving 4888 patients: 50% White, 14% Black, 12% Asian, 23% Hispanic. In univariate analysis, compared with Whites, Blacks had fewer witnessed arrests (83% vs 86%, p = 0.03) and less bystander CPR (37% vs 44%, p = 0.005), were less likely to undergo coronary angiography (14% vs 22%, p < 0.0001), and less likely to receive PCI (32% vs 54%, p < 0.0001). Asians presented less often with a shockable rhythm (27% vs 34%, p = 0.001) and were less likely to undergo angiography (15% vs 22%, p < 0.0001). Hispanics presented less often with a shockable rhythm (31% vs 34%, p = 0.03), had fewer witnessed arrests (82% vs 86%, p = 0.001) and less bystander CPR (37% vs 44%, p = 0.0001). In multivariable analysis, Hispanic ethnicity was associated with decreased favorable neurologic outcome (OR 0.78 [95%CI 0.63-0.96]). Outcomes for Asians and Blacks did not differ from Whites. When accounting for clustering by hospital, race was no longer statistically significantly associated with survival with good neurologic outcome.

Conclusion: We identified important differences in patients with OHCA according to race/ethnicity. Such differences may have implications for interventions; for example, emphasis on bystander CPR instruction in Black and Hispanic communities.

Keywords: Cardiopulmonary arrest; Ethnicity; Race.

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation
  • Coronary Angiography
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Los Angeles
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / ethnology*
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Outcome Assessment, Health Care*
  • Percutaneous Coronary Intervention
  • Retrospective Studies
  • Survival Analysis