Relationship between neighbourhood deprivation and ethnicity with attendance of prehospital critical care to out-of-hospital cardiac arrest patients.

BACKGROUND

Health inequalities exist throughout the chain of survival for out-of-hospital cardiac arrest (OHCA) patients. Prehospital critical care attendance is associated with improved outcomes, however it is unknown whether these services mitigate or exacerbate pre-existing inequalities.

AIM: To examine the relationship between neighbourhood deprivation and ethnicity on prehospital critical care attendance to OHCA patients.

METHODS

All OHCA patients treated by three neighbouring ambulance services in England between 2018-2023 were included. Prehospital critical care was defined as any provider with clinical competencies beyond that of standard paramedics following Joint Royal Colleges Ambulance Liaison Committee guidelines and dedicated dispatch to critically ill patients. Neighbourhood characteristics of the incident location were obtained. Mixed-effects logistic regression models were constructed of clinical variables influencing prehospital critical care attendance and neighbourhood ethnicity and deprivation. Sensitivity analyses were conducted for missing data and using alternative modelling techniques.

RESULTS

The study included 61,011 patients, of which 16,144 (26.5%) were attended by a prehospital critical care asset. Helicopter Emergency Medical Services attended 13,772 patients (85.5% of prehospital critical care) and arrived by helicopter to 7,403 patients. Prehospital critical care teams were more likely to attend OHCAs with favourable clinical prognostic factors, or special circumstance arrests (asphyxia, drowning, traumatic). Prehospital critical care attendance was increased in more affluent neighbourhoods (adjusted odds ratio 1.034, 95% confidence interval 1.025-1.043). This association was consistent across sensitivity and subgroup analyses. Amongst subgroups, the strongest association was amongst doctor-led services (1.056, 1.044-1.068) and the weakest amongst paramedic-led services (1.014, 1.001-1.026). No relationship was detected between neighbourhood ethnicity in adjusted analyses. Female patients were less likely to receive a prehospital critical care response in all analyses.

CONCLUSION

Prehospital critical care teams were less likely to attend cardiac arrest patients in more deprived neighbourhoods, while no association was found with neighbourhood ethnicity.