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Abstract

Introduction: Across seven large North American urban populations, Pittsburgh, PA, had the highest crude rate of cardiac arrests based on an analysis of the ROC database. This discrepancy was most pronounced in adult patients 18-64yo residing in census tracks with the lowest median household income. The purpose of this study was to examine the prevalence of pre-existing medical risk factors (e.g. body mass index, diabetes) and socioeconomic factors (e.g. insurance and employment status) within those resuscitated from cardiac arrest using a high resolution database and to examine the impact of these on outcomes. Methods: A retrospective analysis of all treated in- and out-of hospital cardiac arrest patients aged 18-64yo at 2 inner-city Pittsburgh hospitals during a 16-month period was analyzed. We abstracted data on demographics and a number of socioeconomic factors such as insurance, employment, drug abuse and marital status as well as medical historical details. Patient's residences were geocoded and depicted in a map of Allegheny, which also contained census tracts color coded by poverty status. Multivariate regression was used to determine factors independently associated with survival to hospital discharge and neurologic outcome (CPC 1-2). Results: From 3/2011-7/2012, 418 patients aged 18-64yo were treated for cardiac arrest at UPMC Presbyterian and Mercy hospitals. Among those 95 patients treated at Mercy hospital, 69 (72.6%) resided in Allegheny County at time of arrest, 25 (36.2%) were living in a neighborhood with 20-30% poverty at the time of arrest. 19 patients (20.2%) had a history of drug abuse, and 20 (23.2%) had an illicit drug identified on urine drug screen. At time of arrest, 69 patients (72.6%) were unemployed or disabled. The median body mass index (BMI) for all 95 patients was 30 kg/m2 (IQR: 25 to 38). Among all 418 patients, 235 (56.2%) were unmarried, 180 (43.1%) had no private insurance. 27 patients (5.7%) did not have any next of kin listed. 168 patients (40.2%) survived to hospital discharge and 77 (18.8%) had CPC 1-2. In a multivariate regressions only presenting rhythm was significantly associated with survival (p=0.006). Conclusions: Younger adults treated for cardiac arrest in Pittsburgh differed from the rest of Allegheny County in their high incidence of unemployment, lack of insurance, living alone, being obese and drug abuse. These factors should be targeted in public health interventions.