Abstract 264: Impact of Receiving Hospital on Disparities in Out-of-Hospital Cardiac Arrest

Abstract

Background: Minority out-of-hospital cardiac arrest (OHCA) victims suffer from worse outcomes. The factors contributing to these disparities are not completely understood, and little is known about the impact of receiving hospital on OHCA. Hypothesis: Receiving hospital plays an important role in OHCA outcome disparities. Methods: We performed a retrospective, cohort study of the national Cardiac Arrest Registry to Enhance Survival (CARES). We included OHCAs from 2014- 2021 that survived to hospital admission. Based on census tract data, we stratified OHCAs based on majority race/ethnicity: >50% White, >50% Black, and >50% Hispanic/Latino. We stratified hospitals into quartiles based on hospital rate of the outcome, survival with favorable neurologic outcome, cerebral performance category of 1 of 2. We evaluated the association between race/ethnicity and care at increasing hospital performance quartile. We compared four models evaluating the association between race/ethnicity and outcome: 1) omitting receiving hospital and bystander CPR (B-CPR), 2) adjusting for B-CPR, 2) additionally adjusting for receiving hospital as a random intercept, and 3) adjusting for hospital performance quartile. We adjusted all models for possible confounders. Results: We include 124,908 OHCAs that survived to hospital admission; 90,034 majority White, 20,600 majority Black, and 14,338 majority Hispanic. Compared to White, Black (OR 0.1, 95% CI 0.1-0.1) and Hispanic OHCAs were less likely to be cared for at high performing hospitals. Ignoring receiving hospital, outcomes were worse for Black (19.7%, aOR 0.43, 95% CI 0.40-0.46) and Hispanic (22.1%, aOR 0.49, 95% CI 0.45-0.54) than White (33.5%). While adjusting for B-CPR did not change survival odds, adjusting for receiving hospital as a random intercept improved outcome odds for Black (aOR 0.60, 95% CI 0.54-0.67) and Hispanic (aOR 0.61, 95% CI 0.53-0.69). Adjusting for hospital performance quartile also improved outcome odds for Black (aOR 0.79, 95% CI 0.73-0.85) and Hispanic/Latino (aOR 0.78, 95% CI 0.70-0.86). Conclusion: OHCAs from minority communities were less likely to be cared for at higher performing hospitals, and adjusting for receiving hospital significantly diminished OHCA outcome disparities.