Survival After Out-of-Hospital Cardiac Arrest: The Role of Racial Residential Segregation

Overview

Journal J Urban Health

Publisher Springer

Specialty General Medicine

Date 2022 Oct 10

PMID 36216971

Authors

Ethan E Abbott

David G Buckler

Jesse Y Hsu

Sara F Jacoby

Benjamin S Abella

Lynne D Richardson

Brendan G Carr

Alexis M Zebrowski

Affiliations

Soon will be listed here.

Abstract

Racial and racialized economic residential segregation has been empirically associated with outcomes across multiple health conditions but not yet explored in relation to out-of-hospital cardiac arrest (OHCA). We sought to examine if measures of racial and economic residential segregation are associated with differences in survival to discharge after OHCA for Black and White Medicare beneficiaries. Utilizing age-eligible Medicare fee-for-service claims data from 2013 to 2015, we identified OHCA claims and determined survival to discharge. The primary predictor, residential segregation, was calculated using the index of concentration at the extremes (ICE) for the beneficiary residential ZIP code. Multilevel modified Poisson regression models were used to determine the association of OHCA outcomes and ZIP code level ICE measures. In total, 194,263 OHCA cases were identified among beneficiaries residing in 75% of US ZIP codes. Black beneficiaries exhibited 12.1% survival to discharge, compared with 12.5% of White beneficiaries. In fully adjusted models of the three ICE measures accounting for differences in treating hospital characteristics, there was as high as a 28% (RR 1.28, CI 1.23-1.26) higher relative likelihood of survival to discharge in the most segregated White ZIP codes (Q5) as compared to the most segregated Black ZIP codes (Q1). Racial residential segregation is independently associated with disparities in OHCA outcomes; among Medicare beneficiaries who generated a claim after suffering an OHCA, ICE measures of racial segregation are associated with a lower likelihood of survival to discharge for those living in the most segregated Black and lower income quintiles compared to higher quintiles.

Citing Articles

Joint Modeling of Social Determinants and Clinical Factors to Define Subphenotypes in Out-of-Hospital Cardiac Arrest Survival: Cluster Analysis.

Abbott E, Oh W, Dai Y, Feuer C, Chan L, Carr B JMIR Aging. 2023; 6:e51844.

PMID: 38059569 PMC: 10721134. DOI: 10.2196/51844.

Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries.

Abbott E, Buckler D, Hsu J, Abella B, Richardson L, Carr B J Am Heart Assoc. 2023; 12(19):e030138.

PMID: 37750559 PMC: 10727234. DOI: 10.1161/JAHA.123.030138.

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