Pediatric out-of-hospital cardiac arrest outcomes by Child Opportunity Index, race and ethnicity.

OBJECTIVE

To evaluate the association between Child Opportunity Index (COI) and race and ethnicity and pediatric out-of-hospital cardiac arrest (OHCA) outcomes and the role of bystander response (bystander cardiopulmonary resuscitation and/or defibrillator use) as a mediator.

METHODS

This is a retrospective cohort study using the Cardiac Arrest Registry to Enhance Survival (CARES) of children ≤18 years with OHCA. The exposures are COI quintiles (very low indicates the most disadvantaged neighborhoods) and race and ethnicity. The primary outcome is survival to hospital discharge with favorable neurological outcome (Pediatric Cerebral Performance Category ≤2). Associations of exposures with outcome are determined using logistic regression and mediation analysis is used to evaluate the indirect effect of bystander response.

RESULTS

Overall, 1654/17,903 (9.2%) had a favorable outcome. Arrests in lower COI neighborhoods and in Black/African American children occurred more frequently in infants and were less likely to be witnessed and to receive bystander response. Arrests in very low COI areas (vs very high COI, adjusted odds ratio aOR 0.68 [95% CI 0.54-0.84], P < 0.001) and Black/African American race (vs White, aOR 0.81 [95% CI 0.69-0.96], P = 0.02) were independently associated with lower odds of a favorable outcome. Lower bystander response partially mediated worse outcomes associated with lower COI quintiles (adjusted percent mediated: 11.7% [95% CI 5.5-17.9], P < 0.001) and Black/African American race (15.6% [95% CI 7.5-23.6], P < 0.001).

CONCLUSIONS

Arrests occurring in lower COI areas and among Black/African American children are associated with lower odds of a favorable outcome. Lower bystander response partially explains these associations.