Association of Neighborhood Race and Income With Survival After Out-of-Hospital Cardiac Arrest

Background For individuals with an out-of-hospital cardiac arrest (OHCA), survival may be influenced by the neighborhood in which the arrest occurs. Methods and Results Within the national CARES (Cardiac Arrest Registry to Enhance Survival) registry, we identified 169 502 patients with OHCA from 2013 to 2017. On the basis of census tract data, OHCAs were categorized as occurring in predominantly white (>80% white), majority black (>50% black), or integrated (neither of these 2) neighborhoods and in low-income (median household <$40 000), middle-income ($40 000 to $80 000), or high-income (>$80 000) neighborhoods. With hierarchical logistic regression, the association of neighborhood race and income on overall survival was assessed. Overall, 37.5%, 16.6%, and 45.9% of people had an OHCA in predominantly white, majority black, and integrated neighborhoods, and 30.1%, 53.4%, and 16.5% in low-, middle-, and high-income neighborhoods, respectively. Compared with OHCAs occurring in predominantly white neighborhoods, those in majority black neighborhoods were 12% less likely (6.9% versus 10.6%; adjusted odds ratio 0.88; 95% CI 0.82-0.95; P<0.001) to survive to discharge, whereas those in integrated neighborhoods had similar survival (10.3% versus 10.6%; adjusted odds ratio 1.00; 95% CI 0.96-1.04; P=0.93). Compared with high-income neighborhoods, those in middle-income neighborhoods were 11% (10.1% versus 11.3%; adjusted odds ratio 0.89; 95% CI 0.8-0.94; P<0.001) less likely to survive to discharge, whereas those in low-income neighborhoods were 12% (8.6% versus 11.3%; adjusted odds ratio 95% CI 0.83-0.94; P<0.001) less likely to survive. Differential rates of bystander cardiopulmonary resuscitation only modestly attenuated neighborhood differences in survival. Conclusions OHCAs in majority black and non-high-income neighborhoods have lower survival rates, and these differences were not explained by differential bystander cardiopulmonary resuscitation rates.