Abstract 11228: Social Determinants of Rates of Resuscitation in Out-of-Hospital Sudden Death Victims

Abstract

Introduction: Cardiac causes contribute to 53% of sudden deaths. Receiving prompt cardiopulmonary resuscitation (CPR) greatly increases survival from out-of-hospital cardiac arrest. However, social factors may contribute to the likelihood of a witnessed arrest and prompt CPR. Our aim was to compare the social demographics of sudden death victims who did receive CPR versus those who did not receive CPR. Methods: Out-of-hospital deaths of adults aged 18-64 in Wake County, NC, from 2013-2015 were adjudicated based on age, cause, and location of death to identify sudden death victims. Sociodemographic background, clinical characteristics, and CPR initiation were gathered from EMS reports, death certificates, and medical records. Descriptive statistics were compared between victims who did versus did not receive CPR. Chi-square (or Fisher’s exact) tests and t-tests were performed to compare categorical and continuous variables, respectively. We used inverse probability weighting for the association between marital status and CPR initiation when CPR initiation status was missing. Results: Of the 399 sudden death victims, CPR was initiated in 131 (32.8%). Compared to those who did not receive CPR, those who did receive CPR were more likely to be Black (42.5% versus 31.0%, p-value 0.035) and live in a high-income census tract (65,539.6 versus 59,951.0, p-value 0.032). Marital status also differed significantly between the groups, with married individuals receiving higher rates of attempted resuscitation than those who were divorced or widowed (p-value 0.012). There was no difference in sex, residence in a rural census tract, history of incarceration, or prevalence of medical comorbidities among those for whom CPR was initiated compared to those for whom CPR was not initiated. Conclusions: Race, marital status, and income level are associated with attempted resuscitation in victims of sudden death. We found conflicting findings on the role race plays in the rate of attempted resuscitation among victims of sudden death. Because our results suggest a varied relationship between social determinants and attempted resuscitation, we propose bystander CPR training across all sociodemographic groups.