Socioeconomic Status Impact on Out-of-Hospital Cardiac Arrest Post-Arrest Care and Outcomes

Introduction: Post-arrest care after out-of-hospital cardiac arrest (OHCA) is critical to optimizing outcomes. Large socioeconomic disparities in prehospital resuscitation interventions have been shown. Less is understood about disparities in post-arrest care and their impact on patient outcomes. We evaluated the association of socioeconomic status (SES) with post-arrest care and outcomes. Methods: We included adult OHCA patients who survived to hospital admission using the 2014-2020 data in Texas from the Cardiac Arrest Registry to Enhance Survival (CARES) . We linked CARES data to census tracts and stratified census tracts above and below the median for SES characteristics: household income, employment rate, and high school graduation. We defined outcomes as targeted temperature management (TTM), Percutaneous Coronary Intervention (PCI), survival to discharge, and survival with a Cerebral Performance Category (CPC) 1-2. We fit a mixed effects model, logistic regression evaluating the association between SES characteristics and outcomes, modeling receiving hospital as the random intercept. We adjusted for age, neighborhood race, sex, bystander witnessed arrest, bystander CPR, and initial shockable rhythm. Results: There were 37,055 adult cases of OHCA taken to 164 hospitals, 9,346 survived to admission; median age was 62, 60.7% were male, 32.5% received TTM, 5.7% received PCI, 34.9% survived to hospital discharge, and 22.0% had a good CPC score. Low employment was associated with low PCI (1.5% v 2.8%, aOR 0.5, 95% CI 0.3-0.9). Low education was linked to worse survival (32.3% v 37.5%, aOR 0.9, 95% CI 0.8-0.99). Low employment was linked to worse CPC (17.5% v 26.4%, aOR 0.8, 95% CI 0.7-0.9). Low income was not associated with TTM (aOR 1.05, 95% CI 0.9-1.2), PCI (aOR 0.9, 95% CI 0.9-1.3), survival (aOR 0.9, 95% CI 0.8-1.0), or good CPC (aOR 1.0, 95% CI 0.9-1.2). Low employment was not associated with TTM (aOR 1.0, 95% CI 0.8-1.1), or survival (aOR 1.0, 95% CI 0.9-1.1). Low education was not associated with low PCI (4.0% v 7.4%, aOR 0.8, 95% CI 0.6-0.1.01), low TTM (aOR 1.0, 95% CI 0.9-1.1), or survival (aOR 0.9, 95% CI 0.8-1.03). Conclusion: SES characteristics were linked to lower PCI rates and worse outcomes, but SES was not associated with TTM.