Sociodemographic disparities in incidence and survival for pediatric out-of-hospital cardiac arrest in the United States

Background: Sociodemographic disparities in pediatric out-of-hospital cardiac arrest (OHCA) outcomes exist; differences in pediatric OHCA incidence remain unknown. This study investigated the association between race, ethnicity, and socioeconomic status (SES) with pediatric OHCA incidence and survival. We hypothesized that children who are Black, Hispanic/Latino, or of lower SES would have higher incidence and lower survival rates compared to children who are White or of higher SES. Methods: This is a retrospective cohort study (2015–2019) of the Cardiac Arrest Registry to Enhance Survival database. We included OHCAs among children < 18 years. The exposures were race, ethnicity, or SES index score. The SES index score incorporated race or ethnicity, household income, high school graduation rates, and unemployment rates on a scale from 0 to 4, with 4 indicating the highest-risk neighborhoods. The primary outcome was incidence (measured per 100,000 children of a particular group). Secondary outcomes included survival to hospital discharge and survival with a favorable neurologic outcome. Results: Among 6945 OHCAs, 2320 (33.4%) occurred in Black children, 739 (10.6%) in Hispanic/Latino children, 2161 (31.1%) in White children, 188 (2.7%) in children of Other race, and 2855 (41.2%) in highest-risk neighborhoods. Black children had the highest OHCA incidence (15.5) as compared to Hispanic/Latino children (3.3) and White children (3.8), p < 0.001. OHCA incidence was higher in highest-risk neighborhoods (11.6) compared to lowest-risk neighborhoods (4.3), p < 0.001. Black children had lower odds of survival to hospital discharge (adjusted odds ratio [aOR] 0.73, 95% CI 0.59–0.91) and neurologically favorable survival (aOR 0.64, 95% CI 0.50–0.82) compared to White children. Hispanic/Latino children did not have significantly worse survival outcomes compared to White children. Children from the highest-risk neighborhoods had lower odds of survival to hospital discharge (aOR 0.64, 95% CI 0.50–0.81) and neurologically favorable survival (aOR 0.54, 95% CI 0.41–0.71) compared to children from the lowest-risk neighborhoods. Conclusions: Black children have over four times the OHCA incidence compared to White and Hispanic/Latino children. Children from the highest-risk neighborhoods have more than twice the OHCA incidence compared to children from the lowest-risk neighborhoods. Black children and children from the highest-risk neighborhoods have significantly lower OHCA survival rates.