Race and ethnicity disparities in post-arrest care in Texas.

Post-arrest care is essential to the chain of survival after out-of-hospital cardiac arrest (OHCA). Sparse literature evaluates disparities in post-arrest care. We sought to measure post-arrest care disparities using a statewide OHCA registry. We evaluated 2014-2020 data in the Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) and included adult OHCAs surviving to hospital admission. We stratified subjects by race/ethnicity. Outcomes were targeted temperature management (TTM), percutaneous intervention (PCI), early withdrawal of life-sustaining therapies (WLST), survival to discharge, and survival with cerebral performance category (CPC) of 1-2 (considered favorable). We used both multivariable and mixed-effects, logistic regression models to evaluate the association between race/ethnicity and outcomes, adjusting for confounders. We modeled receiving hospital as a random intercept for the mixed-models analysis. We included 8,363 OHCAs; 3,916 White, 2,251 Black, 2,196 Hispanic/Latino. On multivariable analysis, Black patients had a lower PCI (aOR 0.4, 95% CI 0.3-0.5) and survival with good CPC (aOR 0.6, 95% CI 0.6-0.7). Hispanic/Latino patients had lower TTM (aOR 0.8, 95% CI 0.7-0.9), PCI (aOR 0.6, 95% CI 0.5-0.8), survival (aOR 0.8, 95% CI 0.7-0.9), and survival with good CPC (aOR 0.7, 95% CI 0.6-0.7). However, after adjusting for clustering by receiving hospital, most of the post-arrest care relationships were negated, and Black patients actually had a higher rate of TTM (aOR 1.2, 95% CI 1.1-1.3). Minority OHCA victims experienced disparities in post-arrest care and outcomes. However, adjusting for receiving hospital random-effect largely diminished these findings. Inter-hospital, post-arrest care disparities may exist.

Informations de copyright

Copyright © 2022. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.