Sex, race, and insurance status differences in hospital treatment and outcomes following out-of-hospital cardiac arrest

Scott D. Casey, Bryn Mumma

Research output: Contribution to journalArticle

9 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)125-129
Number of pages5
JournalResuscitation
Volume126
DOIs
StatePublished - May 1 2018

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Keywords

  • Cardiac arrest
  • Disparities
  • Sex differences

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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