Shin Jenny, Liu Jennifer, Parayil Megin, Counts Catherine R, Drucker Christopher J, Coult Jason, Blackwood Jennifer, Guan Sally, Kudenchuk Peter J, Sayre Michael R, Rea Thomas
Division of Emergency Medical Services, Public Health - Seattle & King County, WA (J.S., J.L., M.P., C.D., J.B., S.G., P.K., T.R.).
Departments of Emergency Medicine (C.R.C., M.S.), University of Washington, Seattle.
Circ Cardiovasc Qual Outcomes. 2025 Mar;18(3):e011446. doi: 10.1161/CIRCOUTCOMES.124.011446. Epub 2025 Jan 23.
Although racial disparities have been described in resuscitation, little is known about potential bias in race classification of out-of-hospital cardiac arrest (OHCA).
We conducted a retrospective cohort study of adults treated by emergency medical services (EMS) for nontraumatic OHCA in King County, WA between January 1, 2018, and December 31, 2021. We assessed agreement using κ and evaluated patterns of missingness between EMS-assessed race versus comprehensive race classification from hospital and death records. Using multivariable logistic regression adjusting for Utstein data elements, we analyzed the association between race and OHCA survival across different sources.
Among 5909 eligible OHCA patients, the average age was 64.0 years, 35.4% were female, and 16.1% survived to hospital discharge. Based on comprehensive race classification, 68.7% were White, 12.8% Black, 12.1% Asian, 2.5% multiracial, 2.3% Native Hawaiian/other Pacific Islander, and 1.6% American Indian/Alaska Native. EMS did not classify race in 43.7%. The κ coefficient between EMS and comprehensive race classification was 0.88 (95% CI, 0.86-0.90), though agreement varied substantially by specific race and was lowest among American Indian/Alaska Native (39.5%). Missingness in EMS records varied according to race and was greater among those classified as American Indian/Alaska Native (60.8%), Native Hawaiian/other Pacific Islander (58.8%), Asian (57.8%), or multiracial (54.1%) compared with White (40.6%) or Black (40.4%). In multivariable models using EMS-classified race, the odds ratio (OR) of survival was not significantly different for any race group compared with the White race, that is, OR. However, when using comprehensive race classification, OR of survival was significantly lower among Native Hawaiian/other Pacific Islander (OR, 0.57 [95% CI, 0.33-0.97]) and among multiracial (OR, 0.40 [95% CI, 0.20-0.75]) compared with White race.
In adult OHCA, race misclassification and missingness influenced its association with survival. Efforts should continue to evaluate best practices to classify race correctly and comprehensively.
尽管在复苏过程中已描述了种族差异，但对于院外心脏骤停（OHCA）种族分类中的潜在偏差知之甚少。
我们对2018年1月1日至2021年12月31日期间在华盛顿州金县接受紧急医疗服务（EMS）治疗的非创伤性OHCA成年患者进行了一项回顾性队列研究。我们使用κ系数评估一致性，并评估EMS评估的种族与医院和死亡记录中的综合种族分类之间的缺失模式。使用针对Utstein数据元素进行调整的多变量逻辑回归，我们分析了不同来源的种族与OHCA生存率之间的关联。
在5909名符合条件的OHCA患者中，平均年龄为64.0岁，35.4%为女性，16.1%存活至出院。根据综合种族分类，68.7%为白人，12.8%为黑人，12.1%为亚洲人，2.5%为多种族，2.3%为夏威夷原住民/其他太平洋岛民，1.6%为美洲印第安人/阿拉斯加原住民。EMS未对43.7%的患者进行种族分类。EMS与综合种族分类之间的κ系数为0.88（95%CI，0.86 - 0.90），尽管一致性因特定种族而异，在美洲印第安人/阿拉斯加原住民中最低（39.5%）。EMS记录中的缺失情况因种族而异，与白人（40.6%）或黑人（40.4%）相比，在被分类为美洲印第安人/阿拉斯加原住民（60.8%）、夏威夷原住民/其他太平洋岛民（58.8%）、亚洲人（57.8%）或多种族（54.1%）的患者中更高。在使用EMS分类种族的多变量模型中，与白人种族相比，任何种族组的生存优势比（OR）均无显著差异，即OR。然而，当使用综合种族分类时，与白人种族相比，夏威夷原住民/其他太平洋岛民（OR，0.57 [95%CI，0.33 - 0.97]）和多种族（OR，0.40 [95%CI，0.20 - 0.75]）的生存OR显著较低。
在成人OHCA中，种族错误分类和缺失影响了其与生存的关联。应继续努力评估正确和全面分类种族的最佳实践。
