Bernardin Mary E, Arora Jyoti, Schuler Paul, Fisher Benjamin, Finney Joseph, Kendrick Elizabeth, Lee Danielle
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, 1 Hospital Drive, Columbia, MO 65212, United States.
Division of Pediatric Emergency Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO 63110, United States.
Resusc Plus. 2024 Oct 4;20:100795. doi: 10.1016/j.resplu.2024.100795. eCollection 2024 Dec.
Social determinants of health (SDOH) impact health disparities, though little is known about the effects of SDOH on pediatric out-of-hospital cardiac arrest (POHCA).
This cross-sectional study utilized the NEMSIS Database to obtain nationwide POHCA data from 2021 to 2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). SDOH data was obtained from the US Census Bureau and included minority race/ethnicities status, poverty levels, and educational attainment of the community where POCHAs occurred. Multivariable logistic regression and Cochran-Armitage trend tests were used to assess associations between SDOH and POHCA outcomes.
Query of the NEMSIS Database yielded 27,137 POHCAs. The odds of CPR performance and obtainment of ROSC were significantly higher (p < 0.001) in communities with lower levels of minority races/ethnicities. The odds of bystander CPR, AED usage, and obtainment of ROSC all increased significantly (p < 0.001) in the wealthiest communities compared to the poorest communities. The odds of bystander AED usage (p = 0.001) and ROSC (p = 0.003) were significantly higher in communities with the highest educational attainment. As the minority status and poverty level of the community increased and educational attainment decreased, there was a significant decreasing trend (p < 0.001) in performance of bystander CPR, AED usage, and obtainment of ROSC.
Community-level SDOH, including increasing community minority status, poverty levels, and decreasing educational attainment, are associated with less bystander CPR, AED usage, and ROSC obtainment in POHCAs. Understanding SDOH offers opportunities for public health interventions addressing disparities in POHCA outcomes.
健康的社会决定因素（SDOH）会影响健康差异，不过关于SDOH对儿童院外心脏骤停（POHCA）的影响却知之甚少。
这项横断面研究利用国家院外心脏骤停登记系统（NEMSIS）数据库获取2021年至2023年的全国POHCA数据。结果包括旁观者心肺复苏（CPR）的实施情况、自动体外除颤器（AED）的使用情况以及自主循环恢复（ROSC）的实现情况。SDOH数据来自美国人口普查局，包括POHCA发生社区的少数族裔地位、贫困水平和教育程度。采用多变量逻辑回归和 Cochr an - Armitage趋势检验来评估SDOH与POHCA结果之间的关联。
对NEMSIS数据库的查询产生了27137例POHCA。在少数族裔水平较低的社区，实施CPR和实现ROSC的几率显著更高（p < 0.001）。与最贫困社区相比，最富裕社区中旁观者进行CPR、使用AED和实现ROSC的几率均显著增加（p < 0.001）。在教育程度最高的社区，旁观者使用AED的几率（p = 0.001）和实现ROSC的几率（p = 0.003）显著更高。随着社区的少数族裔地位和贫困水平增加以及教育程度降低，旁观者实施CPR、使用AED和实现ROSC的情况呈显著下降趋势（p < 0.001）。
社区层面的SDOH，包括社区少数族裔地位增加、贫困水平上升和教育程度下降，与POHCA中旁观者进行CPR、使用AED以及实现ROSC的情况减少有关。了解SDOH为解决POHCA结果差异的公共卫生干预提供了机会。
