Affiliation:
1. Texas Emergency Medicine Research Center McGovern Medical School Houston TX USA
2. Department of Emergency Medicine McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) Houston TX USA
3. Department of Emergency Medicine University of Iowa Iowa City IA USA
4. Department of Emergency Medicine and Center for Resuscitation Science University of Pennsylvania Philadelphia PA USA
5. Department of Emergency Medicine Emory University Atlanta GA USA
6. School of Public Health UTHealth Houston Houston TX USA
Abstract
Background
Factors associated with out‐of‐hospital cardiac arrest (OHCA) outcome disparities remain poorly understood. We evaluated the role of receiving hospital on OHCA outcome disparities.
Methods and Results
We studied people with OHCA who survived to hospital admission from TX‐CARES (Texas Cardiac Arrest Registry to Enhance Survival), 2014 to 2021. Using census data, we stratified OHCAs into majority (>50%) strata: non‐Hispanic White race and ethnicity, non‐Hispanic Black race and ethnicity, and Hispanic or Latino ethnicity. We stratified hospitals into performance quartiles based on the primary outcome, survival with good neurologic outcome. We evaluated the association between race and ethnicity and care at higher‐performance hospitals. We compared 3 models evaluating the association between race and ethnicity and outcome: (1) ignoring hospital, (2) adjusting for hospital as a random intercept, and (3) adjusting for hospital performance quartile. We adjusted models for possible confounders. We included 10 434 OHCAs. Hospital performance quartile outcome rates ranged from 11.3% (fourth) to 37.1% (first). Compared with OHCAs in neighborhoods of majority White race, those in neighborhoods of majority Black race (odds ratio [OR], 0.1 [95% CI, 0.1–0.1]) and Hispanic or Latino ethnicity (OR, 0.2 [95% CI, 0.2–0.2]) were less likely to be cared for at higher‐performing hospitals. Compared with White neighborhoods (30.1%) and ignoring hospital, outcomes were worse in Black neighborhoods (15.4%; adjusted OR [aOR], 0.5 [95% CI, 0.4–0.5]) and Hispanic or Latino neighborhoods (19.2%; aOR, 0.6 [95% CI, 0.5–0.7]). Adjusting for hospital as a random intercept, outcomes improved for Black neighborhoods (aOR, 0.9 [95% CI, 0.7–1.05]) and Hispanic or Latino neighborhoods (aOR, 0.9 [95% CI, 0.8–0.99]). Adjusting for hospital performance quartile, outcomes improved for Black neighborhoods (aOR, 0.8 [95% CI, 0.7–1.01]) and Hispanic or Latino neighborhoods (aOR, 0.9 [95% CI, 0.8–0.996]).
Conclusions
In Black and Hispanic or Latino communities, OHCAs were less likely to be cared for at higher‐performing hospitals, and adjusting for receiving hospital improved OHCA outcome disparities.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
1 articles.
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