Huebinger Ryan, Vithalani Veer, Osborn Lesley, Decker Cameron, Jarvis Jeff, Dickson Robert, Escott Mark, White Lynn, Al-Araji Rabab, Nikonowicz Peter, Villa Normandy, Panczyk Micah, Wang Henry, Bobrow Bentley
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Department of Emergency Medicine, Houston, TX, USA.
Office of the Medical Director, MedStar Mobile Healthcare, Fort Worth, TX, USA; JPS Health Network, Department of Emergency Medicine, Fort Worth, TX, USA.
Resuscitation. 2021 Mar 30;163:101-107. doi: 10.1016/j.resuscitation.2021.03.021.
Large racial and socioeconomic inequalities exist for out-of-hospital cardiac arrest (OHCA) care and outcomes. We sought to characterize racial, ethnic, and socioeconomic disparities in OHCA care and outcomes in Texas.
We analyzed 2014-2018 Texas-Cardiac Arrest Registry to Enhance Survival (CARES) data. Using census tracts, we defined race/ethnicity neighborhoods based on majority race/ethnicity composition: non-Hispanic/Latino white, non-Hispanic/Latino black, and Hispanic/Latino. We also stratified neighborhoods into socioeconomic categories: above and below the median for household income, employment rate, and high school graduation. We defined outcomes as bystander CPR rates, public bystander AED use, and survival to hospital discharge. Using mixed models, we analyzed the associations between outcomes and neighborhood (1) racial/ethnic categories and (2) socioeconomic categories.
We included data on 18,488 OHCAs. Relative to white neighborhoods, black neighborhoods had lower rates of AED use (OR 0.3, CI 0.2-0.4), and Hispanic/Latino neighborhoods had lower rates of bystander CPR (OR 0.7, CI 0.6-0.8), AED use (OR 0.4, CI 0.3-0.6), and survival (OR 0.8, CI 0.7-0.8). Lower income was associated with a lower rates of bystander CPR (OR 0.8, CI 0.7-0.8), AED use (OR 0.5, CI 0.4-0.8), and survival (OR 0.9, CI 0.9-0.98). Lower high school graduation was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.9) and AED use (OR 0.6, CI 0.4-0.9). Higher unemployment was associated with lower rates of bystander CPR (OR 0.9, CI 0.8-0.94) and AED use (OR 0.7, CI 0.5-0.99).
Minority and poor neighborhoods in Texas experience large and unacceptable disparities in OHCA bystander response and outcomes.
院外心脏骤停（OHCA）的护理及预后存在巨大的种族和社会经济不平等。我们试图描述德克萨斯州OHCA护理及预后方面的种族、民族和社会经济差异。
我们分析了2014 - 2018年德克萨斯州心脏骤停登记以提高生存率（CARES）的数据。利用普查区，我们根据多数种族/民族构成定义了种族/民族社区：非西班牙裔/拉丁裔白人、非西班牙裔/拉丁裔黑人以及西班牙裔/拉丁裔。我们还将社区分为社会经济类别：家庭收入、就业率和高中毕业率中位数以上和以下。我们将预后定义为旁观者心肺复苏（CPR）率、公众旁观者自动体外除颤器（AED）的使用情况以及出院生存率。使用混合模型，我们分析了预后与社区（1）种族/民族类别和（2）社会经济类别之间的关联。
我们纳入了18488例OHCA的数据。与白人社区相比，黑人社区AED的使用率较低（比值比[OR] 0.3，置信区间[CI] 0.2 - 0.4），西班牙裔/拉丁裔社区旁观者CPR率（OR 0.7，CI 0.6 - 0.8）、AED使用率（OR 0.4，CI 0.3 - 0.6）和生存率（OR 0.8，CI 0.7 - 0.8）较低。低收入与旁观者CPR率（OR 0.8，CI 0.7 - 0.8）、AED使用率（OR 0.5，CI 0.4 - 0.8）和生存率（OR 0.9，CI 0.9 - 0.98）较低相关。高中毕业率较低与旁观者CPR率（OR 0.8，CI 0.7 - 0.9）和AED使用率（OR 0.6，CI 0.4 - 0.9）较低相关。较高的失业率与旁观者CPR率（OR 0.9，CI 0.8 - 0.94）和AED使用率（OR 0.7，CI 0.5 - 0.99）较低相关。
德克萨斯州的少数族裔和贫困社区在OHCA旁观者反应及预后方面存在巨大且不可接受的差异。
