Racial and Ethnic and Sex Disparities in the Outcomes and Treatment of In-Hospital Cardiac Arrest: A Nationwide Analysis From the United States.

Abstract

Background: In-hospital cardiac arrest (IHCA) is associated with significant morbidity and mortality. The relationships between race and ethnicity and sex on outcomes and treatment patterns among patients with IHCA remain poorly understood.

Methods and results: We conducted a retrospective study using the National (Nationwide) Inpatient Sample (NIS) database from 2016 to 2020 to identify adult patients with IHCA and examine the associations between in-hospital outcomes and race and ethnicity (White, Black, Hispanic) and sex. The primary outcome was in-hospital mortality. Secondary outcomes included rates of in-hospital procedures. Multivariable logistic regression analysis was used to adjust for potential confounders. Among 207 770 patients with IHCA, 26.6% had ventricular tachycardia/ventricular fibrillation and 73.4% had pulseless electrical activity/asystole. For ventricular tachycardia/ventricular fibrillation arrest, Black men (adjusted odds ratio [aOR], 1.42 [95% CI, 1.21-1.66]), Black women (aOR, 1.25 [95% CI, 1.05-1.50]), and Hispanic women (aOR, 1.30 [95% CI, 1.01-1.66]) had higher odds of mortality compared with White men (corresponding adjusted risk ratios [aRRs], 1.10 [CI, 1.06-1.14], 1.06 [95% CI, 1.02-1.11], and 1.08 [95% CI, 1.01-1.14], respectively). In the pulseless electrical activity/asystole arrest subgroup, Black men (aOR, 1.25 [95% CI, 1.11-1.39]) and Hispanic men (aOR, 1.22 [95% CI, 1.07-1.40]) had higher odds of mortality (corresponding aRRs, 1.04 [95% CI, 1.02-1.06] and 1.04 [95% CI, 1.01-1.06], respectively). Black patients with IHCA were less likely to receive percutaneous coronary intervention, coronary artery bypass grafting, and mechanical circulatory support compared with White men.

Conclusions: Significant racial and ethnic and sex disparities exist in outcomes and treatment patterns among patients with IHCA. Targeted efforts and further studies are needed to better understand and address these disparities and improve outcomes.