School of Medicine, University of Southampton, UK.
Eur J Prev Cardiol. 2014 May;21(5):619-38. doi: 10.1177/2047487312451815. Epub 2012 Jun 12.
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.
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.
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).
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.
多项研究报告了院外心脏骤停（OOHCA）特征的种族/民族差异，这些差异得出了不同的结论。我们进行了系统评价，并对考虑患者种族和/或民族时 OOHCA 生存率的差异进行了荟萃分析。
我们检索了 Medline 和 EMBASE 数据库，截至 2011 年 10 月 1 日，以调查 OOHCA 特征的种族/民族差异的研究，并通过相关研究的参考文献进行了手动搜索。我们选择了任何相关设计的研究，这些研究测量了 OOHCA 特征，并按族裔群体进行了分层。两名独立的审查员提取了有关研究人群的信息，包括：根据 Utsein 模板的种族和/或民族、位置、年龄和 OOHCA 变量。我们对比较黑人和白人患者的研究进行了荟萃分析。
在我们的系统搜索中确定了 1701 篇潜在相关文章。在这些文章中，有 22 篇符合纳入标准的原始研究文章进行了审查。尽管有 19 项研究（18 项在美国进行）比较了黑人和白人人群，但只有 15 项符合我们的质量评估标准并进行了荟萃分析。与白人患者相比，黑人患者接受旁观者心肺复苏的可能性较小（OR = 0.66，95%CI = 0.55-0.78），目击者的可能性较小（OR = 0.77，95%CI = 0.72-0.83）或初始室颤/室性心动过速骤停节律（OR = 0.66，95%CI = 0.58-0.76）。黑人患者住院（OR = 0.59，95%CI = 0.48-0.72）和出院（OR = 0.74，95%CI = 0.61-0.90）后的生存率较低。
我们的工作强调了 OOHCA 特征和患者生存与患者种族之间存在显著差异，黑人患者在所有阶段的表现都差得多。大多数研究比较了美国的黑人和白人人群，因此需要在其他地方进行研究，并对其他族裔群体进行研究。这项审查揭示了一种不平等现象，迫切需要采取行动。
