The role of hospital performance on race and ethnicity outcome disparities for US non-traumatic out-of-hospital cardiac arrests.

Abstract

Background: Factors contributing to worse outcomes for out-of-hospital cardiac arrests (OHCA) from minoritized communities are poorly understood. We sought to evaluate the impact of receiving hospital performance on OHCA outcome disparities.

Methods: We performed a retrospective cohort study of non-traumatic OHCAs from the National Cardiac Arrest Registry to Enhance Survival from 2013 to 2022 that survived hospital admission. We created cohorts based on census-tract race/ethnicity: >50% White, >50% Black, and >50% Hispanic/Latino. We stratified hospitals into performance quartiles based on hospital good neurologic outcome rates. We evaluated the association between race/ethnicity and care at better-performing hospitals. Using hierarchical modeling, we compared models evaluating the association between community race/ethnicity and outcomes, ignoring and adjusting for receiving hospital.

Results: We included 202,117 OHCAs. Compared to White, OHCAs from Black (OR 0.12[0.12-0.13]) and Hispanic/Latino (OR 0.21[0.20-0.21]) communities had lower odds of care at higher-performing hospitals, but care at higher-performing hospitals improved outcomes for all groups: White - OR 1.43[1.41-1.44]), Black - OR 1.54[1.50-1.59]), Hispanic/Latino - 1.51[1.46-1.56]. Ignoring receiving hospital, outcomes were worse for OHCAs from Black (aOR 0.56[0.54-0.58]) and Hispanic/Latino (aOR 0.63[0.61-0.66]) communities. Although adjusting for bystander cardiopulmonary resuscitation did not change results, adjusting for hospital performance quartile improved outcome odds (Black - aOR 0.80[0.76-0.84]; Hispanic/Latino - aOR 0.82[0.78-0.86]). Adjusting for receiving hospital random effect also improved outcome odds (Black - aOR 0.84[0.81-0.87]; Hispanic Latino - aOR 0.86[0.83-0.90]).

Conclusions: OHCAs from Black and Hispanic/Latino communities received care at high-performing hospitals less often, and adjusting for receiving hospital significantly diminished OHCA outcome disparities.