Racial differences in out-of-hospital cardiac arrest survival and treatment
- Columbia University, Mailman School of Public Health, Department of Health Policy and Management New York City, New York, USA
- Correspondence to Dr Elizabeth Ty Wilde, Columbia University, Mailman School of Public Health, 600 West 168th Street, 6th Floor, New York, NY 10032, USA;
Contributors ETW had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: ETW, JCP. Acquisition of data: ETW. Analysis and interpretation of data: ETW, JCP, LSR. Drafting of the manuscript: ETW, JCP, LSR. Critical revision of the manuscript for important intellectual content: ETW, JCP, LSR. Statistical analysis: ETW, JCP. Administrative, technical, or material support: ETW, LSR. Study supervision: ETW, JCP.
- Accepted 30 March 2011
- Published Online First 5 May 2011
Objectives 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 Database with out-of-hospital cardiac arrest as a primary or secondary indication for emergency medical service (EMS) dispatch between 1 January 1996 and 31 December 2004.
Results Return of spontaneous circulation was lower for black patients (19.8%) than for white patients (26.3%) (unadjusted OR 0.69, 95% CI 0.53 to 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 CI just transposing 1.00 (adjusted OR 0.71, 95% CI 0.50 to 1.01, p=0.053).
Conclusions Blacks were less likely to experience a return of spontaneous circulation than whites, less likely to receive defibrillation or cardiopulmonary resuscitation from EMS and more likely to receive medications 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.
- Emergency medical services
- cardiac arrest
- racial Disparity
- Cardio-pulmonary Resuscitation
- cardiac care
- acute myocardial infarct
- emergency ambulance systems
- nursing, pre-hospital
This manuscript has not been presented at any meetings; a preliminary version of this work was presented at a seminar at New York University, New York City on 18 May 2010.
Ethics approval This study was conducted with the approval of the Columbia University Institutional Review Board (IRB approval number: AAAD3234).
Provenance and peer review Not commissioned; externally peer reviewed.