Abstract 13150: Racial/Ethnic Disparities of the Impact of the COVID-19 Pandemic Out-of-Hospital Cardiac Arrest (OHCA) in Texas

Abstract

Introduction: Prior research shows a greater disease burden, lower BCPR rates, and worse outcomes in Black and Hispanic patients after OHCA. The CDC has declared that the COVID-19 pandemic has disproportionately affected many racial and ethnic minority groups. However, the influence of the COVID-19 pandemic on OHCA incidence and outcomes in different races and ethnicities is unknown. Purpose: To describe racial/ethnic disparities in OHCA incidence, processes of care and outcomes in Texas during the COVID-19 pandemic. Methods: We used data from the Texas Cardiac Arrest Registry to Enhance Survival (CARES) comparing adult OHCA from the pre-pandemic period (March 11 - December 31, 2019) to the pandemic period (March 11- December 31, 2020). The racial and ethnic categories were White, Black, Hispanic or Other. Outcomes were rates of BCPR, AED use, sustained ROSC, prehospital termination of resuscitation (TOR), survival to hospital admission, survival to discharge and good neurological outcomes. We fit a mixed effect logistic regression model, with EMS agency designated as the random intercept to obtain aORs. We adjusted for the pandemic and other covariates. Results: A total of 8,070 OHCAs were included. The proportion of cardiac arrests increased for Blacks (903 to 1, 113, 24.9% to 25.5%) and Hispanics (935 to 1,221, 25.8% to 27.5%) and decreased for Whites (1 595 to 1,869, 44.0% to 42.1%) and Other (194 to 220, 5.4% to 5.0%) patients. Compared to Whites, Black (aOR = 0.73, 95% CI 0.65-0.82) and Hispanic patients (aOR = 0.78, 95% CI 0.68-0.87) were less likely to receive BCPR. Compared to Whites, Blacks were less likely to have sustained ROSC (aOR = 0.81, 95% CI 0.70-0.93%), with lower rates of survival to hospital admission (aOR = 0.87, 95% CI 0.75-1.0), and worse neurological outcomes (aOR = 0.45, 95% 0.28-0.73). Hispanics were less likely to have prehospital TOR compared to Whites (aOR = 0.86, 95% CI = 0.75-0.99). The Utstein bystander survival rate was worse for Blacks (aOR = 0.72, 95% CI 0.54-0.97) and Hispanics (aOR = 0.71, 95% 0.53-0.95) compared to Whites. Conclusion: Racial and ethnic disparities persisted during the COVID-19 pandemic in Texas.