Abstract 261: Association Of Neighborhood Social Determinants Of Health With Adverse Out-of-hospital Cardiac Arrest (OHCA) Outcomes Among Medicare Beneficiaries

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death with prior studies demonstrated worse OHCA outcomes in neighborhoods with higher proportion of Blacks and lower socioeconomic status. The association between OHCA outcomes and other social determinants of health (SDOHs) like limited English proficiency (LEP) and education is not well studied. Hypothesis: We hypothesized patients living in neighborhoods with high proportion of LEP had worse OHCA outcomes. We chose survival to hospital admission as the primary outcome due to its proximity to reflect a neighborhood’s characteristics. Methods: We performed a two-level hierarchical logistic-regression model. Patient data were Medicare fee-for-service claims between January 1, 2013, and December 31, 2015 (level 1). Neighborhood characteristics for the area in which each OHCA occurred were derived from the 2014 American Community Survey at the ZCTA level (level 2). We identified six neighborhood SDOH predictors of interest including LEP, median household income, racial and ethnic-group composition, percent unemployment, less than high school education, and population density. Results: Among the 194,231 OHCA events identified, 60,760 (31.3%) survived to hospital admission. Contrary to our hypothesis, Patient who had a cardiac arrest in the highest proportion of LEP neighborhoods were more likely to survive to hospital admission as compared to those living in predominantly English-speaking neighborhoods (OR 1.16; 95% CI, 1.10 to 1.23). Household income, racial composition, and unemployment had no effect on the likelihood of survival to hospital admission in OHCA while education and population density appeared to be protective (Table) . Conclusions: In a large cohort study, we found that patients who had an out of hospital cardiac arrest were more likely to survive to hospital admission in higher LEP, higher education, and higher population density neighborhoods.