美国非创伤性院外心脏骤停的医院表现对种族和民族结果差异的作用

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation Pub Date : 2025-01-16 DOI:10.1016/j.resuscitation.2025.110496

Ryan Huebinger, Marina Del Rios, Benjamin S Abella, Bryan McNally, Carrie Bakunas, Richard Witkov, Joseph Gill, Bentley Bobrow

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引用次数: 0

摘要

背景：对少数族裔社区院外心脏骤停（OHCA）预后较差的因素了解甚少。我们试图评估接收医院表现对OHCA结果差异的影响。方法：我们对来自国家心脏骤停登记处的非创伤性ohca进行了一项回顾性队列研究，以提高2013-2022年住院后的生存率。我们根据人口普查区的种族/民族建立了队列：50%为白人，50%为黑人，50%为西班牙裔/拉丁裔。我们根据医院良好的神经系统转归率将医院分为表现四分位数。我们评估了种族/民族与表现较好的医院护理之间的关系。使用分层模型，我们比较了评估社区种族/民族与结果之间关系的模型，忽略并调整了接收医院。结果：纳入了202,117例ohca。与白人相比，黑人社区（OR 0.12[0.12-0.13]）和西班牙裔/拉丁裔社区（OR 0.21[0.20-0.21]）的ohca在高绩效医院接受治疗的几率较低，但在高绩效医院接受治疗改善了所有组的预后：白人- OR 1.43[1.41-1.44])，黑人- OR 1.54[1.50-1.59])，西班牙裔/拉丁裔- 1.51[1.46-1.56]。忽略住院治疗，黑人社区（aOR为0.56[0.54-0.58]）和西班牙裔/拉丁裔社区（aOR为0.63[0.61-0.66]）的ohca预后更差。虽然对旁观者心肺复苏进行调整没有改变结果，但对医院表现进行调整可提高结果的几率(Black - aOR为0.80[0.76-0.84]；西班牙裔/拉丁裔- aOR 0.82[0.78-0.86])。调整接受医院随机效应也提高了结局的几率(Black - aOR 0.84[0.81-0.87]；拉美裔- aOR 0.86[0.83-0.90])。结论：来自黑人和西班牙裔/拉丁裔社区的OHCA在高绩效医院接受治疗的频率较低，并且根据接受医院进行调整可显著降低OHCA结果差异。

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

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.

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来源期刊

Resuscitation 医学-急救医学

CiteScore

12.00

自引率

18.50%

发文量

556

审稿时长

21 days

期刊介绍： Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.