Abstract 260: Sociodemographic Analysis of Paediatric Out-of-Hospital Cardiac Arrest in Ontario, Canada: A Province-Wide Case-Control Study

Abstract

Background: Paediatric out-of-hospital cardiac arrest (POHCA) is associated with significant mortality and severe neurological sequelae. Previous literature indicates that there are sociodemographic disparities in POHCA survival and in the provision of upstream interventions. However, it’s unclear if the populations impacted by these disparities also have an elevated risk of experiencing POHCA. We sought to describe the relationship between sociodemographic factors and POHCA risk in Ontario, Canada. Methods: We conducted a province-wide case-control study using health administrative data at ICES. The case group included children (1 day to 17 years of age) who experienced an OHCA between 2004 and 2020. Controls were matched up to 1:4 on age, sex, index date, and key comorbidities. We used conditional logistic regression to measure the association between POHCA and neighbourhood-level marginalization indicators, geographical context, and immigration status. Results: The case and control groups included 1,826 and 7,254 children, respectively. Children living in areas with the highest levels of material deprivation (adjusted odds ratio, aOR: 2.35, 95% CI: 1.94, 2.85) and dependency (aOR: 1.23, 95% CI: 1.02, 1.49) had a higher odds of POHCA, relative to children living in regions with the lowest levels of material deprivation and dependency, respectively. Children living in neighbourhoods with the lowest levels of ethnic diversity had a higher odds of POHCA (aOR: 1.34, 95% CI: 1.08, 1.67), as compared to children living in neighbourhoods with the highest levels of ethnic diversity. Northern urban (aOR: 1.42, 95% CI: 1.11, 1.82) and southern rural residence (aOR: 1.27, 95% CI: 1.04, 1.55) were associated with a higher odds of POHCA, relative to southern urban residence. The odds of POHCA were lower in child immigrants (aOR: 0.60, 95% CI: 0.42, 0.85) and maternal immigrants (aOR: 0.70, 95% CI: 0.61, 0.81), relative to the general population. The impact of residential instability was not significant in adjusted analyses. Conclusion: Children living in neighbourhoods with high levels of marginalization are likely at an elevated risk of experiencing POHCA. These communities should be prioritized in POHCA prevention and intervention efforts.