Abstract 134: Survival After Out-of-hospital Cardiac Arrest: The Role of Urban-rural Residence and Demographic Factors

Abstract

Introduction: Survival to discharge after out-of-hospital cardiac arrest (OHCA) exhibits significant regional variability across communities in the US with differences in outcomes following arrest between rural, suburban, and urban communities. We examined the relationship between urban-rural residential county classification and survival following OHCA to determine if racial composition of a county and community health indicators contribute to improved outcomes following OHCA. Methods: Utilizing age-eligible Medicare fee-for-service claims data from January 2013 - December 2014, we identified OHCA patients by ICD-9-CM diagnosis code 427.5 and determined survival to discharge and at 30 days. Additional data sources included the 2013 National Center for Health Statistics (NCHS) urban-rural classification, US Census data, and County Health Rankings. Mixed effect logistic regression was used to determine the association of OHCA outcomes and NCHS classified residence, when accounting for individual age, sex, and race, county-level racial composition, poverty status, and community health measures. Results: 256,107 cases of OHCA were identified with a mean age of age of 78.7 (SD 8.5) years, 22.8% nonwhite, 47.5% female. Overall survival to discharge was 21.8% and survival at 30 days was 15.1%. Patients living in the most rural counties had increased likelihood of initial survival (aOR1.1, CI 1.0-1.1), but were associated with lower survival at 30 days (aOR 0.9, CI 0.8-0.9). Nonwhite patient race and residing in a majority nonwhite county were associated with significant decreases in the likelihood of survival to discharge and at 30 days (7% and 11%, respectively). Conclusions: Among Medicare beneficiaries, survival to discharge after OHCA was higher if residing in a non-urban community but did not persist at 30 days. OHCA patients residing in majority non-white counties were significantly less likely to survive the initial hospitalization and to 30-days post discharge. More study is needed to elucidate these disparities and determine if modifiable county level health factors exist that could contribute to improvements in OHCA survival.