Key result
Wealthiest communities linked to ~98% higher bystander CPR rates in pediatric out-of-hospital cardiac arrest.
Why the study?
Social determinants of health impact health disparities, but little was known about their effects on pediatric out-of-hospital cardiac arrest.
Cross-Sectional (n=27,137)
Yes
Adverse community-level social determinants of health, specifically higher poverty, higher minority prevalence, and lower educational attainment, are significantly associated with decreased rates of bystander CPR, AED use, and ROSC in pediatric out-of-hospital cardiac arrest.
Community wealth disparities were associated with lower bystander CPR in pediatric OHCA; hypothesis-generating and should not yet change practice.
Background: Social determinants of health (SDOH) impact health disparities, though little is known about the effects of SDOH on pediatric out-of-hospital cardiac arrest (POHCA). Methods: This cross-sectional study utilized the NEMSIS Database to obtain nationwide POHCA data from 2021 to 2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). SDOH data was obtained from the US Census Bureau and included minority race/ethnicities status, poverty levels, and educational attainment of the community where POCHAs occurred. Multivariable logistic regression and Cochran-Armitage trend tests were used to assess associations between SDOH and POHCA outcomes. Results: Query of the NEMSIS Database yielded 27,137 POHCAs. The odds of CPR performance and obtainment of ROSC were significantly higher (p < 0.001) in communities with lower levels of minority races/ethnicities. The odds of bystander CPR, AED usage, and obtainment of ROSC all increased significantly (p < 0.001) in the wealthiest communities compared to the poorest communities. The odds of bystander AED usage (p = 0.001) and ROSC (p = 0.003) were significantly higher in communities with the highest educational attainment. As the minority status and poverty level of the community increased and educational attainment decreased, there was a significant decreasing trend (p < 0.001) in performance of bystander CPR, AED usage, and obtainment of ROSC. Conclusions: Community-level SDOH, including increasing community minority status, poverty levels, and decreasing educational attainment, are associated with less bystander CPR, AED usage, and ROSC obtainment in POHCAs. Understanding SDOH offers opportunities for public health interventions addressing disparities in POHCA outcomes.
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Bernardin et al. (2024) conducted a cross-sectional in Pediatric out-of-hospital cardiac arrest (POHCA) (n=27,137). Lowest community poverty level (≤5%) vs. Highest community poverty level (≥26%) was evaluated on Performance of bystander CPR (OR 1.98, 95% CI 1.72-2.28, p=<0.001). The wealthiest communities (≤5% poverty level) were associated with a 98% higher odds of bystander CPR performance (OR 1.98) compared to communities with the highest poverty levels (≥26%) during pediatric out-of-hospital cardiac arrests.
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