Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
JAMA Netw Open. 2021 Jul 1;4(7):e2118537. doi: 10.1001/jamanetworkopen.2021.18537.
Sudden cardiac arrest (SCA) is a major public health problem. Owing to a lack of population-based studies in multiracial/multiethnic communities, little information is available regarding race/ethnicity-specific epidemiologic factors of SCA.
To evaluate the association of race/ethnicity with burden, outcomes, and clinical profile of individuals experiencing SCA.
DESIGN, SETTING, AND PARTICIPANTS: A 5-year prospective, population-based cohort study of out-of-hospital SCA was conducted from February 1, 2015, to January 31, 2020, among residents of Ventura County, California (2018 population, 848 112: non-Hispanic White [White], 45.8%; Hispanic/Latino [Hispanic], 42.4%; Asian, 7.3%; and Black, 1.7% individuals). All individuals with out-of-hospital SCA of likely cardiac cause and resuscitation attempted by emergency medical services were included.
Data on circumstances and outcomes of SCA from prehospital emergency medical services records and data on demographics and pre-SCA clinical history from detailed archived medical records, death certificates, and autopsies.
Annual age-adjusted SCA incidence by race and ethnicity and SCA circumstances and outcomes by ethnicity. Clinical profile (cardiovascular risk factors, comorbidity burden, and cardiac history) by ethnicity, overall, and stratified by sex.
A total of 1624 patients with SCA were identified (1059 [65.2%] men; mean [SD] age, 70.9 [16.1] years). Race/ethnicity data were available for 1542 (95.0%) individuals, of whom 1022 (66.3%) were White, 381 (24.7%) were Hispanic, 86 (5.6%) were Asian, 31 (2.0%) were Black, and 22 (1.4%) were other race/ethnicity. Annual age-adjusted SCA rates per 100 000 residents of Ventura County were similar in White (37.5; 95% CI, 35.2-39.9), Hispanic (37.6; 95% CI, 33.7-41.5; P = .97 vs White), and Black (48.0; 95% CI, 30.8-65.2; P = .18 vs White) individuals, and lower in the Asian population (25.5; 95% CI, 20.1-30.9; P = .006 vs White). Survival to hospital discharge following SCA was similar in the Asian (11.8%), Hispanic (13.9%), and non-Hispanic White (13.0%) (P = .69) populations. Compared with White individuals, Hispanic and Asian individuals were more likely to have hypertension (White, 614 [76.3%]; Hispanic, 239 [79.1%]; Asian, 57 [89.1%]), diabetes (White, 287 [35.7%]; Hispanic, 178 [58.9%]; Asian, 37 [57.8%]), and chronic kidney disease (White, 231 [29.0%]; Hispanic, 123 [40.7%]; Asian, 33 [51.6%]) before SCA. Hispanic individuals were also more likely than White individuals to have hyperlipidemia (White, 380 [47.2%]; Hispanic, 165 [54.6%]) and history of stroke (White, 107 [13.3%]; Hispanic, 55 [18.2%]), but less likely to have a history of atrial fibrillation (White, 251 [31.2%]; Hispanic, 59 [19.5%]).
The results of this study suggest that the burden of SCA was similar in Hispanic and White individuals and lower in Asian individuals. The Asian and Hispanic populations had shared SCA risk factors, which were different from those of the White population. These findings underscore the need for an improved understanding of race/ethnicity-specific differences in SCA risk.
心脏骤停（SCA）是一个主要的公共卫生问题。由于缺乏多种族/多种族社区的基于人群的研究，因此关于 SCA 的种族/民族特异性流行病学因素的信息很少。
评估种族/民族与 SCA 患者的负担、结局和临床特征之间的关联。
设计、地点和参与者：对加利福尼亚州文图拉县的院外 SCA 进行了为期 5 年的前瞻性、基于人群的队列研究，研究时间为 2015 年 2 月 1 日至 2020 年 1 月 31 日，研究对象为该县的居民（2018 年人口为 848112 人：非西班牙裔白人[白人]占 45.8%；西班牙裔/拉丁裔[西班牙裔]占 42.4%；亚洲人占 7.3%；黑人占 1.7%）。所有具有可能由心脏原因引起的院外 SCA 且由紧急医疗服务机构进行复苏尝试的个体均被纳入研究。
从院前急救医疗服务记录中获取 SCA 情况和结局的数据，从详细的存档病历、死亡证明和尸检中获取人口统计学和 SCA 前临床病史的数据。
按种族和民族计算的 SCA 年发生率以及按种族计算的 SCA 情况和结局。按种族（心血管危险因素、合并症负担和心脏病史）、总体和按性别分层的临床特征。
共确定了 1624 例 SCA 患者（男性 1059 例[65.2%]；平均[标准差]年龄为 70.9[16.1]岁）。有 1542 名（95.0%）患者的种族/民族数据可用，其中 1022 名（66.3%）为白人，381 名（24.7%）为西班牙裔，86 名（5.6%）为亚洲人，31 名（2.0%）为黑人，22 名（1.4%）为其他种族/民族。文图拉县每 100000 名居民的年 SCA 发生率校正后白人（37.5；95%CI，35.2-39.9）、西班牙裔（37.6；95%CI，33.7-41.5；P = .97 与白人相比）和黑人（48.0；95%CI，30.8-65.2；P = .18 与白人相比）相似，而亚洲人群（25.5；95%CI，20.1-30.9；P = .006 与白人相比）较低。SCA 后存活至出院的患者中，亚洲人（11.8%）、西班牙裔（13.9%）和非西班牙裔白人（13.0%）（P = .69）相似。与白人相比，西班牙裔和亚洲裔患者发生高血压（白人：287[35.7%]；西班牙裔：239[79.1%]；亚洲裔：57[89.1%]）、糖尿病（白人：287[35.7%]；西班牙裔：178[58.9%]；亚洲裔：37[57.8%]）和慢性肾脏疾病（白人：231[29.0%]；西班牙裔：123[40.7%]；亚洲裔：33[51.6%]）的可能性更高。与白人相比，西班牙裔患者发生高脂血症（白人：380[47.2%]；西班牙裔：165[54.6%]）和卒中史（白人：107[13.3%]；西班牙裔：55[18.2%]）的可能性更高，但发生心房颤动史的可能性更低（白人：251[31.2%]；西班牙裔：59[19.5%]）。
这项研究的结果表明，西班牙裔和白人的 SCA 负担相似，而亚洲人的负担较低。亚洲人和西班牙裔人群具有共同的 SCA 危险因素，这些危险因素与白人人群不同。这些发现强调了需要更好地了解 SCA 风险的种族/民族特异性差异。
