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American Journal of Epidemiology Advance Access originally published online on June 21, 2007
American Journal of Epidemiology 2007 166(5):534-543; doi:10.1093/aje/kwm102
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Explaining Racial Disparities in Incidence of and Survival from Out-of-Hospital Cardiac Arrest

S Galea1,2, S Blaney2, A Nandi3, R Silverman4, D Vlahov2,3, G Foltin5, M Kusick2, M Tunik5 and N Richmond6,7

1 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
2 Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY
3 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
4 Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
5 Department of Pediatrics and Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY
6 New York City Fire Department, New York, NY
7 Louisville Metro Emergency Medical Services, Louisville, KY

Correspondence to Dr. Sandro Galea, Department of Epidemiology, University of Michigan School of Public Health, 1214 South University Avenue, Ann Arbor, MI 48104 (e-mail: sgalea{at}umich.edu).

Received for publication January 5, 2007. Accepted for publication March 7, 2007.

A prospective observational study of 4,653 consecutive cases of out-of-hospital cardiac arrest (OOHCA) occurring in New York City from April 1, 2002, to March 31, 2003, was used to assess racial/ethnic differences in the incidence of OOHCA and 30-day survival after hospital discharge among OOHCA patients. The age-adjusted incidence of OOHCA per 10,000 adults was higher among Blacks than among persons in other racial/ethnic groups, and age-adjusted survival from OOHCA was higher among Whites compared with other groups. In analyses restricted to 3,891 patients for whom complete data on all variables were available, the age-adjusted relative odds of survival from OOHCA among Blacks were 0.4 (95% confidence interval: 0.2, 0.7) as compared with Whites. A full multivariable model accounting for demographic factors, prior functional status, initial cardiac rhythm, and characteristics of the OOHCA event explained approximately 41 percent of the lower age-adjusted survival among Blacks. The lower prevalence of ventricular fibrillation as the initial cardiac rhythm among Blacks relative to Whites was the primary contributor. A combination of factors probably accounts for racial/ethnic disparities in OOHCA survival. Previously hypothesized factors such as delays in emergency medical service response or differences in the likelihood of receipt of cardiopulmonary resuscitation did not appear to be substantial contributors to these racial/ethnic disparities.

African Americans; emergency medical services; ethnic groups; heart arrest; myocardial infarction; New York City; urban health

Abbreviations: CPR, cardiopulmonary resuscitation; EMS, Emergency Medical Services; FDNY, Fire Department of New York


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