Does race or socioeconomic status predict adverse outcome after out of hospital cardiac arrest: a multi-center study☆
Introduction
Outcome from an out-of hospital cardiac arrest has been characterized to be dependent on a few well defined factors. These include whether the collapse was witnessed; whether cardiopulmonary resuscitation was initiated on the victim; the time interval from collapse to defibrillation; location of the arrest; whether the victim was older than 79; and initial cardiac rhythm [1], [2], [3], [4], [5], [6], [7], [8]. Previous literature has suggested race as a predictor of survival after an out-of-hospital cardiac arrest (OHCA), with blacks having worse outcomes than whites [9], [10]. Chu et al suggested that socioeconomic status (SES) may be a confounder in this observation of worse outcomes between the races, finding no statistical difference in outcome in an affluent suburban population [11]. However, the external validity of this paper is limited by use of a primarily affluent, suburban population for both races. An improved survival as a result of higher SES may be linked to such factors as better preventative health care, improved general health, or earlier activation of emergency medical systems as a result of better education [12], [13]. Differences in outcome by race may be linked to variation in the prevalence, character and severity of co-morbid states such as hypertension, diabetes, and congestive heart failure [14], [15], [16].
Our objective in this study is to assess whether race independent of SES is associated with improved rate of survival after an OHCA in a more economically and geographically diverse study population. Our null hypothesis is that there is no difference in the rate of survival between races when controlling for socioeconomic status and other known predictors of OHCA outcome.
Section snippets
Materials and methods
We performed a retrospective cohort study of OHCA of presumed cardiac origin, with race as the risk factor and discharged alive from hospital as the outcome measure. Our study period was between 1991 and 1996 from seven urban–suburban municipalities in Michigan—Royal Oak, Pontiac, Southfield, Oak Park, Ann Arbor, Kalamazoo, and Ypsilanti—which range in population from 24 846 to 109 592. These cities all had similar EMS systems and were selected because they provided a diverse population of race
Results
A total of 1682 cases were gathered during the study period, of which 361 were excluded due to missing data on outcome, race, census tract median income, and/or cardiac arrest was not of primary cardiac origin (exclusions: 18, <18 years; three, sex unknown; 66, unknown discharge status; 118, race unknown; 15, race not black or white; 145 census tract or address data unknown). Of the remaining 1317 cases (78.2%) with complete data for analysis, the average age was 67.3±16.0, 939 (71.1%) were
Discussion
Out of hospital cardiac arrest studies in large cities (Chicago, New York) have documented dismal survival rates after OHCA [19], [20]. While some identify EMS system and access issues as potential reasons for this low survival, these studies raise the question of whether race, SES, or perhaps both, are factors in this low survival. Previous literature has documented an inverse relationship between SES and coronary artery disease mortality rates [21]. Could associated factors, such as a lack of
Conclusion
Our initial finding in this study was that blacks do have a worse outcome after OHCA.
However, after controlling for SES and variables normally predictive of OHCA survival, in an urban and suburban environment, race and SES did not independently predict outcome after OHCA.
Acknowledgements
Funded by Grant #RI-92-03 from the William Beaumont Hospital Research Institute.
References (25)
- et al.
Prehospital cardiac arrest—a critical analysis of factors affecting survival
Resuscitation
(1989) - et al.
Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation
Am J Emerg Med
(1985) - et al.
Prehospital cardiac arrest: the impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times
Ann Emerg Med
(1990) - et al.
The location of collapse and its effect on survival from cardiac arrest
Ann Emerg Med
(1987) - et al.
Race and survival after out of hospital cardiac arrest in a suburban community
Ann Emerg Med
(1998) - et al.
Outcome of CPR in a large metropolitan area—where are the survivors?
Ann Emerg Med
(1991) - et al.
Methodology for data collection to study prehospital cardiac arrest in New York city: The PHASE methodology
Ann Emerg Med
(1994) - et al.
Do blacks get bystander cardiopulmonary resuscitation as often as whites?
Ann Emerg Med
(1994) - et al.
Racial and socioeconomic aspects of myocardial infarction recovery: studying confounds
Am J Prev Med
(1991) - et al.
Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation
Am J Public Health
(1979)
Prehospital cardiopulmonary resuscitation—is it effective?
J Am Med Assoc
Cited by (50)
Migration or ethnicity: The importance of context and categorization
2023, ResuscitationRacial Disparity in Outcomes of Out-of-Hospital Cardiac Arrest (OHCA): A Systematic Review and Meta-Analysis
2023, Current Problems in CardiologyAssociation of measures of socioeconomic position with survival following out-of-hospital cardiac arrest: A systematic review
2020, ResuscitationCitation Excerpt :Firstly, there was variation in whether the SEP measures referred to the OHCA patient, either as individual-level measures for the patient or their household7–15 or area-level measures based on the patient's residential address,5,13,15–20 or whether they referred to area-level SEP at the OHCA location.21–28 Several different SEP measures were used, including measures of income,5,7,13,14,17–21,26,27 poverty,15,21,23 education,5,9,14,26 property value,11–13,27 employment,10,15,21 occupation,9 crime rate,16 and housing.8 Others used a composite measure incorporating several indicators.22,24,25,28
- ☆
Presented at SAEM Annual Meeting, Chicago, IL, May, 1998.