Huebinger Ryan, Panczyk Micah, Villa Normandy, Al-Araji Rabab, Schulz Kevin, Humphries Amanda, Gill Joseph, Persse David, J Bobrow Bentley
Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas.
Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
Prehosp Emerg Care. 2023;27(8):1076-1082. doi: 10.1080/10903127.2023.2188331. Epub 2023 Mar 24.
First responder (FR) cardiopulmonary resuscitation (CPR) is an important component of out-of-hospital cardiac arrest (OHCA) care. However, little is known about FR CPR disparities.
We linked the 2014-2021 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) database to census tract data. We included non-traumatic OHCAs that were not witnessed by 9-1-1 responders and did not receive bystander CPR. We defined census tracts as having >50% of a race/ethnicity: White, Black, or Hispanic/Latino. We also stratified patients into quartiles based on socioeconomic status (SES): household income, high school graduation, and unemployment. We also combined race/ethnicity and income to create a total of five mixed strata, comparing lower income and minority census tracts to high income White census tracts. We created mixed model logistic regression models, adjusting for confounders and modeling census tract as a random intercept. Using the models, we compared FR CPR rates for census race/ethnicity (Black and Hispanic/Latino compared to White), and SES quartiles (2nd, 3rd, and 4th quartiles compared to 1st quartiles). Secondarily, we evaluated the association between FR CPR and survival for all strata.
We included 21,966 OHCAs, and 57.4% had FR CPR. Evaluating the association between census tract characteristic and FR CPR, majority Black (aOR 0.30, 95% CI 0.22-0.41) had a lower bystander CPR rate when compared to majority White. The lowest income quartile had a lower rate of bystander CPR (aOR 0.80, 95% CI 0.65-0.98). The worst unemployment quartile was also associated with a lower rate of FR CPR (aOR 0.75, 95% CI 0.61-0.92). Combining race/ethnicity and income, middle income majority Black (30.0%; aOR 0.27, 95% CI 0.17-0.46) and low income >80% Black (31.8%; aOR 0.27, 95% CI 0.10-0.68) had lower rates of FR CPR in comparison to high income majority White. There were no associations between Hispanic or lower high school graduation and lower rates of FR CPR. We found no association between FR CPR and survival for all three strata.
While we identified disparities in FR CPR in low SES and majority Black census tracts, we identified no association between FR CPR and survival in Texas.
急救人员（FR）进行的心肺复苏（CPR）是院外心脏骤停（OHCA）护理的重要组成部分。然而，关于FR心肺复苏的差异知之甚少。
我们将2014 - 2021年德克萨斯州心脏骤停登记以提高生存率（TX - CARES）数据库与普查区数据相链接。我们纳入了非创伤性OHCA，这些病例未被911急救人员目击且未接受旁观者心肺复苏。我们将普查区划分为某一种族/族裔占比>50%的区域：白人、黑人或西班牙裔/拉丁裔。我们还根据社会经济地位（SES）将患者分为四分位数：家庭收入、高中毕业率和失业率。我们还将种族/族裔和收入相结合，创建了总共五个混合阶层，将低收入和少数族裔普查区与高收入白人普查区进行比较。我们创建了混合模型逻辑回归模型，对混杂因素进行调整，并将普查区建模为随机截距。使用这些模型，我们比较了不同普查种族/族裔（黑人与西班牙裔/拉丁裔与白人相比）以及SES四分位数（第二、第三和第四四分位数与第一四分位数相比）的FR心肺复苏率。其次，我们评估了所有阶层中FR心肺复苏与生存率之间的关联。
我们纳入了21,966例OHCA病例，其中57.4%接受了FR心肺复苏。评估普查区特征与FR心肺复苏之间的关联时，黑人占多数的地区（调整后比值比[aOR]为0.30，95%置信区间[CI]为0.22 - 0.41）与白人占多数的地区相比，旁观者心肺复苏率较低。收入最低的四分位数区域旁观者心肺复苏率较低（aOR为0.80，95% CI为0.65 - 0.98）。失业率最差的四分位数区域也与较低的FR心肺复苏率相关（aOR为0.75，95% CI为0.61 - 0.92）。将种族/族裔和收入相结合后，中等收入黑人占多数的地区（30.0%；aOR为0.27，95% CI为0.17 - 0.46）和低收入且黑人占比>80%的地区（31.8%；aOR为0.27，95% CI为0.10 - 0.68）与高收入白人占多数的地区相比，FR心肺复苏率较低。西班牙裔或高中毕业率较低与较低的FR心肺复苏率之间没有关联。我们发现所有三个阶层中FR心肺复苏与生存率之间均无关联。
虽然我们发现了低SES和黑人占多数的普查区在FR心肺复苏方面存在差异，但在德克萨斯州，我们未发现FR心肺复苏与生存率之间存在关联。
