Segregation by Income, Race Affects OOH Cardiac Arrest Survival

Eileen Gamagami, PhD

November 18, 2022

The study covered in this summary was published on medRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Among Medicare beneficiaries who survived to discharge after out-of-hospital cardiac arrest (OHCA), the 3-year risk of death from any cause was significantly lower for those residing in predominately White and economically privileged ZIP codes, compared with majority Black and lower-income ZIP codes.

  • Socioeconomic measures based on income were stronger predictors of survival than such measures based on race.

Why This Matters

  • This study identified race-related disparities in OHCA mortality by residential and economic segregation that could potentially create barriers to fundamental needs of OHCA survivors such as transportation, access to follow-up medical care, and medications.

Study Design

  • In this retrospective study based on Medicare fee-for-service claims data covering 2013 to 2015, race at the patient level was defined only as Black, White, or Other due to the small proportion of beneficiaries that were not Black or White.

  • The index of concentration at the extremes (ICE), an established measure of racial and economic segregation, was assessed by annual income at 20th and 80th percentiles; by race; and by income and race.

  • ICE scores were arranged by quintile, the highest and lowest reflecting the most and least economically advantaged residential regions, respectively.

  • The primary outcome was 3-year survival.

  • Random-effects Cox proportional hazards models were used to analyze three types of ICE measures for each outcome, with adjustment for beneficiary demographics, hospital characteristics, and procedures at index hospitalization.

 Key Results

  • The study included 29,847 OHCA claims for beneficiaries who survived to discharge after OHCA; all had at least 3.5 years of follow-up data.

  • The mean beneficiary age was 75; 40.1% of them were female, 80% were White, and 15.2% were Black.

  • Black and White beneficiaries showed similar comorbidity burdens.

  • Overall crude survival rates for the cohort were 54% at 1 year and 40.8% at 3 years.

  • The hazard ratio (HR) for 3-year death from any cause for the most vs least economically advantaged regions (quintiles five and one, respectively) by the race ICE component was 0.84 (95% CI, 0.79-0.88); by the income ICE component was 0.76 (95% CI, 0.73-0.81); and by the race/income ICE component was 0.78 (95% CI, 0.74-0.83).

Limitations

  • Important clinical predictors such as initial arrest rhythm, emergency-medical service response times, location of OHCA, and whether there was bystander cardiopulmonary resuscitation could not be included in the analysis.

  • Not all racial and ethnic groups could be included or rigorously analyzed in the study.

Disclosures

  • The study was funded by the Emergency Medicine Foundation Health Disparities Grant.

  • The authors declared no competing interests.

This is a summary of a preprint research study, “The Association of Racial Residential Segregation and Long-Term Outcomes after Out-Of-Hospital Cardiac Arrest Among Medicare Beneficiaries," written by Ethan E. Abbott from the Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine and Department of Population Health Science and Policy, New York, New York, and colleagues on medRxiv.org, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on medRxiv.org.

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