Scott D Casey1, Bryn E Mumma2. 1. Albert Einstein College of Medicine, USA; Department of Emergency Medicine, University of California Davis, USA. 2. Department of Emergency Medicine, University of California Davis, USA. Electronic address: bemumma@ucdavis.edu.
Abstract
BACKGROUND: Sex, race, and insurance status are associated with treatment and outcomes in several cardiovascular diseases. These disparities, however, have not been well-studied in out-of-hospital cardiac arrest (OHCA). OBJECTIVE: Our objective was to evaluate the association of patient sex, race, and insurance status with hospital treatments and outcomes following OHCA. METHODS: We studied adult patients in the 2011-2015 California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Database with a "present on admission" diagnosis of cardiac arrest (ICD-9-CM 427.5). Insurance status was classified as private, Medicare, and Medi-Cal/government/self-pay. Our primary outcome was good neurologic recovery at hospital discharge, which was determined by discharge disposition. Secondary outcomes were survival to hospital discharge, treatment at a 24/7 percutaneous coronary intervention (PCI) center, "do not resuscitate" orders within 24 h of admission, and cardiac catheterization during hospitalization. Data were analyzed with hierarchical multiple logistic regression models. RESULTS: We studied 38,163 patients in the OSHPD database. Female sex, non-white race, and Medicare insurance status were independently associated with worse neurologic recovery [OR 0.94 (0.89-0.98), 0.93 (0.88-0.98), and 0.85 (0.79-0.91), respectively], lower rates of treatment at a 24/7 PCI center [OR 0.89 (0.85-0.93), 0.88 (0.85-0.93), and 0.87 (0.82-0.94), respectively], and lower rates of cardiac catheterization [OR 0.61 (0.57-0.65), 0.90 (0.84-0.97), and 0.44 (0.40-0.48), respectively]. Female sex, white race, and Medicare insurance were associated with DNR orders within 24 h of admission [OR 1.16 (1.10-1.23), 1.14 (1.07-1.21), and 1.25 (1.15-1.36), respectively]. CONCLUSIONS: Sex, race, and insurance status were independently associated with post-arrest care interventions, patient outcomes and treatment at a 24/7 PCI center. More studies are needed to fully understand the causes and implications of these disparities.
BACKGROUND: Sex, race, and insurance status are associated with treatment and outcomes in several cardiovascular diseases. These disparities, however, have not been well-studied in out-of-hospital cardiac arrest (OHCA). OBJECTIVE: Our objective was to evaluate the association of patient sex, race, and insurance status with hospital treatments and outcomes following OHCA. METHODS: We studied adult patients in the 2011-2015 California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Database with a "present on admission" diagnosis of cardiac arrest (ICD-9-CM 427.5). Insurance status was classified as private, Medicare, and Medi-Cal/government/self-pay. Our primary outcome was good neurologic recovery at hospital discharge, which was determined by discharge disposition. Secondary outcomes were survival to hospital discharge, treatment at a 24/7 percutaneous coronary intervention (PCI) center, "do not resuscitate" orders within 24 h of admission, and cardiac catheterization during hospitalization. Data were analyzed with hierarchical multiple logistic regression models. RESULTS: We studied 38,163 patients in the OSHPD database. Female sex, non-white race, and Medicare insurance status were independently associated with worse neurologic recovery [OR 0.94 (0.89-0.98), 0.93 (0.88-0.98), and 0.85 (0.79-0.91), respectively], lower rates of treatment at a 24/7 PCI center [OR 0.89 (0.85-0.93), 0.88 (0.85-0.93), and 0.87 (0.82-0.94), respectively], and lower rates of cardiac catheterization [OR 0.61 (0.57-0.65), 0.90 (0.84-0.97), and 0.44 (0.40-0.48), respectively]. Female sex, white race, and Medicare insurance were associated with DNR orders within 24 h of admission [OR 1.16 (1.10-1.23), 1.14 (1.07-1.21), and 1.25 (1.15-1.36), respectively]. CONCLUSIONS: Sex, race, and insurance status were independently associated with post-arrest care interventions, patient outcomes and treatment at a 24/7 PCI center. More studies are needed to fully understand the causes and implications of these disparities.
Authors: James E Calvin; Matthew T Roe; Anita Y Chen; Rajendra H Mehta; Gerard X Brogan; Elizabeth R Delong; Dan J Fintel; W Brian Gibler; E Magnus Ohman; Sidney C Smith; Eric D Peterson Journal: Ann Intern Med Date: 2006-11-21 Impact factor: 25.391
Authors: Clifton W Callaway; Michael W Donnino; Ericka L Fink; Romergryko G Geocadin; Eyal Golan; Karl B Kern; Marion Leary; William J Meurer; Mary Ann Peberdy; Trevonne M Thompson; Janice L Zimmerman Journal: Circulation Date: 2015-11-03 Impact factor: 29.690
Authors: Bryn E Mumma; Brigitte M Baumann; Deborah B Diercks; Kevin M Takakuwa; Caren F Campbell; Frances S Shofer; Anna Marie Chang; Molly K Jones; Judd E Hollander Journal: Ann Emerg Med Date: 2010-12-13 Impact factor: 5.721
Authors: James X Zhang; Elbert S Huang; Melinda L Drum; Anne C Kirchhoff; Jennifer A Schlichting; Cynthia T Schaefer; Loretta J Heuer; Marshall H Chin Journal: Am J Public Health Date: 2008-09-17 Impact factor: 9.308
Authors: Marisa A Bittoni; Randy Wexler; Colleen K Spees; Steven K Clinton; Christopher A Taylor Journal: Prev Med Date: 2015-10-09 Impact factor: 4.018
Authors: Bryn E Mumma; Machelle D Wilson; María F García-Pintos; Pablo J Erramouspe; Daniel J Tancredi Journal: Resuscitation Date: 2018-12-24 Impact factor: 5.262
Authors: Dominique J Monlezun; Alfred T Samura; Ritesh S Patel; Tariq E Thannoun; Prakash Balan Journal: Cardiol Res Pract Date: 2021-11-24 Impact factor: 1.866
Authors: Demis Lipe; Al Giwa; Nicholas D Caputo; Nachiketa Gupta; Joseph Addison; Alexis Cournoyer Journal: J Am Heart Assoc Date: 2018-12-04 Impact factor: 5.501