Racial Differences in Out-of-Hospital Cardiac Arrest Survival and Treatment

Background/Purpose: To determine whether there are prehospital differences between blacks and whites experiencing out-of-hospital cardiac arrest and to ascertain which factors are responsible for any such differences. Methods: Cohort study of 3869 adult patients (353 blacks and 3516 whites) in the Illinois Prehospital Dataset with out-of-hospital cardiac arrest as a primary or secondary indication for EMS dispatch between January 1, 1996 and December 31, 2004. Results/Outcomes: Return of spontaneous circulation was lower for black patients (19.8%) than white patients (26.3%) (unadjusted odds ratio, 0.69; 95% confidence interval [CI], 0.53-0.91). After adjusting for age, sex, prior medical history, prehospital event factors, patient zip code characteristics, and EMS agency characteristics, the no difference line was suggestive of a trend, with a confidence interval just transposing 1.00 (adjusted OR, 0.71; 95% CI, (0.50 - 1.01), p=.053). Conclusions: Blacks were less likely to experience a return of spontaneous circulation than whites and less likely to receive defibrillation or CPR from EMS. Differences in underlying health, care prior to the arrival of EMS, and delays in the notification of EMS personnel may contribute to racial disparities in prehospital survival after out-of-hospital cardiac arrest.

Learning Objectives: 1. Describe racial disparities in prehospital outcomes and treatments after out-of-hospital cardiac arrest. 2. Ascertain observed factors associated with these disparities. 3. Discuss potential unobserved factors which may contribute to these disparities.