Racial/ethnic and Gender Disparities of the Impact of the COVID-19 Pandemic in Out-of-hospital Cardiac Arrest (OHCA) in Texas

Overview

Journal Resuscitation

Specialty Emergency Medicine

Date 2022 Aug 6

PMID 35933059

Authors

Summer Chavez

Ryan Huebinger

Hei Kit Chan

Kevin Schulz

Micah Panczyk

Normandy Villa

Renee Johnson

Robert Greenberg

Veer Vithalani

Rabab Al-Araji

Bentley Bobrow

Affiliations

Soon will be listed here.

Abstract

Introduction: Prior research shows a greater disease burden, lower BCPR rates, and worse outcomes in Black and Hispanic patients after OHCA. Female OHCA patients have lower rates of BCPR compared to men and other survival outcomes vary. The influence of the COVID-19 pandemic on OHCA incidence and outcomes in different health disparity populations is unknown.

Methods: We used data from the Texas Cardiac Arrest Registry to Enhance Survival (CARES). We determined the association of both prehospital characteristics and survival outcomes with the pandemic period in each study group through Pearson's χ test or Fisher's exact tests. We created mixed multivariable logistic regression models to compare odds of cardiac arrest care and outcomes between 2019 and 2020 for the study groups.

Results: Black OHCA patients (aOR = 0.73; 95% CI: 0.65 - 0.82) had significantly lower odds of BCPR compared to White OHCA patients, were less likely to achieve ROSC (aOR = 0.86; 95% CI: 0.74 - 0.99) or have a good CPC score (aOR = 0.47; 95% CI: 0.29 - 0.75). Compared to White patients with OHCA, Hispanic persons were less likely to have a field TOR (aOR = 0.86; 95% CI: 0.75 - 0.99) or receive BCPR (aOR = 0.78; 95% CI: 0.69 - 0.87). Female OHCA patients had higher odds of surviving to hospital admission compared to males (aOR = 1.29; 95% CI: 1.15 - 1.44).

Conclusion: Many OHCA outcomes worsened for Black and Hispanic patients. While some aspects of care worsened for women, their odds of survival improved compared to males.

References

Monlezun D, Samura A, Patel R, Thannoun T, Balan P . Racial and Socioeconomic Disparities in Out-Of-Hospital Cardiac Arrest Outcomes: Artificial Intelligence-Augmented Propensity Score and Geospatial Cohort Analysis of 3,952 Patients. Cardiol Res Pract. 2021; 2021:3180987. PMC: 8635948. DOI: 10.1155/2021/3180987. View

Dehingia N, Raj A . Sex differences in COVID-19 case fatality: do we know enough?. Lancet Glob Health. 2020; 9(1):e14-e15. PMC: 7834645. DOI: 10.1016/S2214-109X(20)30464-2. View

Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z . The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020; 24(1):61. PMC: 7036236. DOI: 10.1186/s13054-020-2773-2. View

Leong B . Bystander CPR and survival. Singapore Med J. 2011; 52(8):573-5. View

Hansen C, Kragholm K, Pearson D, Tyson C, Monk L, Myers B . Association of Bystander and First-Responder Intervention With Survival After Out-of-Hospital Cardiac Arrest in North Carolina, 2010-2013. JAMA. 2015; 314(3):255-64. DOI: 10.1001/jama.2015.7938. View

Chavez S, Huebinger R, Chan H, Gill J, White L, Mendez D . The impact of COVID-19 on incidence and outcomes from out-of-hospital cardiac arrest (OHCA) in Texas. Am J Emerg Med. 2022; 57:1-5. PMC: 9005367. DOI: 10.1016/j.ajem.2022.04.006. View

Wadhera R, Shen C, Gondi S, Chen S, Kazi D, Yeh R . Cardiovascular Deaths During the COVID-19 Pandemic in the United States. J Am Coll Cardiol. 2021; 77(2):159-169. PMC: 7800141. DOI: 10.1016/j.jacc.2020.10.055. View

Huebinger R, Vithalani V, Osborn L, Decker C, Jarvis J, Dickson R . Community disparities in out of hospital cardiac arrest care and outcomes in Texas. Resuscitation. 2021; 163:101-107. DOI: 10.1016/j.resuscitation.2021.03.021. View

Lai P, Lancet E, Weiden M, Webber M, Zeig-Owens R, Hall C . Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City. JAMA Cardiol. 2020; 5(10):1154-1163. PMC: 7305567. DOI: 10.1001/jamacardio.2020.2488. View

10.

Mody P, Pandey A, Slutsky A, Segar M, Kiss A, Dorian P . Gender-Based Differences in Outcomes Among Resuscitated Patients With Out-of-Hospital Cardiac Arrest. Circulation. 2020; 143(7):641-649. PMC: 8259883. DOI: 10.1161/CIRCULATIONAHA.120.050427. View

11.

Blom M, Oving I, Berdowski J, van Valkengoed I, Bardai A, Tan H . Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest. Eur Heart J. 2019; 40(47):3824-3834. PMC: 6911168. DOI: 10.1093/eurheartj/ehz297. View

12.

Rodriguez F, Solomon N, de Lemos J, Das S, Morrow D, Bradley S . Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association's COVID-19 Cardiovascular Disease Registry. Circulation. 2020; 143(24):2332-2342. PMC: 8126640. DOI: 10.1161/CIRCULATIONAHA.120.052278. View

13.

Luck A, Preston S, Elo I, Stokes A . The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality. SSM Popul Health. 2021; 17:101012. PMC: 8697426. DOI: 10.1016/j.ssmph.2021.101012. View

14.

Xu F, Zhang Y, Chen Y . Cardiopulmonary Resuscitation Training in China: Current Situation and Future Development. JAMA Cardiol. 2017; 2(5):469-470. DOI: 10.1001/jamacardio.2017.0035. View

15.

Van Dyke M, Greer S, Odom E, Schieb L, Vaughan A, Kramer M . Heart Disease Death Rates Among Blacks and Whites Aged ≥35 Years - United States, 1968-2015. MMWR Surveill Summ. 2018; 67(5):1-11. PMC: 5877350. DOI: 10.15585/mmwr.ss6705a1. View

16.

Andraska E, Alabi O, Dorsey C, Erben Y, Velazquez G, Franco-Mesa C . Health care disparities during the COVID-19 pandemic. Semin Vasc Surg. 2021; 34(3):82-88. PMC: 8349792. DOI: 10.1053/j.semvascsurg.2021.08.002. View

17.

The Lancet . Out-of-hospital cardiac arrest: a unique medical emergency. Lancet. 2018; 391(10124):911. DOI: 10.1016/S0140-6736(18)30552-X. View

18.

Marik P, Deperrior S, Ahmad Q, Dodani S . Gender-based disparities in COVID-19 patient outcomes. J Investig Med. 2021; . DOI: 10.1136/jim-2020-001641. View

19.

Kotini-Shah P, Rios M, Khosla S, Pugach O, Vellano K, McNally B . Sex differences in outcomes for out-of-hospital cardiac arrest in the United States. Resuscitation. 2021; 163:6-13. PMC: 8576847. DOI: 10.1016/j.resuscitation.2021.03.020. View

20.

Blewer A, McGovern S, Schmicker R, May S, Morrison L, Aufderheide T . Gender Disparities Among Adult Recipients of Bystander Cardiopulmonary Resuscitation in the Public. Circ Cardiovasc Qual Outcomes. 2018; 11(8):e004710. PMC: 6209113. DOI: 10.1161/CIRCOUTCOMES.118.004710. View