Temporal Changes in the Racial Gap in Survival After In-Hospital Cardiac Arrest

Lee Joseph; Paul S Chan; Steven M Bradley; Yunshu Zhou; Garth Graham; Philip G Jones; Mary Vaughan-Sarrazin; Saket Girotra

doi:10.1001/jamacardio.2017.2403

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Temporal Changes in the Racial Gap in Survival After In-Hospital Cardiac Arrest

Journal article

Open access

Peer reviewed

Temporal Changes in the Racial Gap in Survival After In-Hospital Cardiac Arrest

Lee Joseph, Paul S Chan, Steven M Bradley, Yunshu Zhou, Garth Graham, Philip G Jones, Mary Vaughan-Sarrazin and Saket Girotra

JAMA cardiology, Vol.2(9), pp.976-984

09/01/2017

DOI: 10.1001/jamacardio.2017.2403

PMCID: PMC5710174

PMID: 28793138

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Abstract

Previous studies have found marked differences in survival after in-hospital cardiac arrest by race. Whether racial differences in survival have narrowed as overall survival has improved remains unknown. To examine whether racial differences in survival after in-hospital cardiac arrest have narrowed over time and if such differences could be explained by acute resuscitation survival, postresuscitation survival, and/or greater temporal improvement in survival at hospitals with higher proportions of black patients. In this cohort study from Get With the Guidelines-Resuscitation, performed from January 1, 2000, through December 31, 2014, a total of 112 139 patients with in-hospital cardiac arrest who were hospitalized in intensive care units or general inpatient units were studied. Data analysis was performed from April 7, 2015, to May 24, 2017. Race (black or white). The primary outcome was survival to discharge. Secondary outcomes were acute resuscitation survival and postresuscitation survival. Multivariable hierarchical (2-level) regression models were used to calculate calendar-year rates of survival for black and white patients after adjusting for baseline characteristics. Among 112 139 patients with in-hospital cardiac arrest, 30 241 (27.0%) were black (mean [SD] age, 61.6 [16.4] years) and 81 898 (73.0%) were white (mean [SD] age, 67.5 [15.2] years). Risk-adjusted survival improved over time in black (11.3% in 2000 and 21.4% in 2014) and white patients (15.8% in 2000 and 23.2% in 2014; P for trend <.001 for both), with greater survival improvement among black patients on an absolute (P for trend = .02) and relative scale (P for interaction = .01). A reduction in survival differences between black and white patients was attributable to elimination of racial differences in acute resuscitation survival (black individuals: 44.7% in 2000 and 64.1% in 2014; white individuals: 47.1% in 2000 and 64.0% in 2014; P for interaction <.001). Compared with hospitals with fewer black patients, hospitals with a higher proportion of black patients with in-hospital cardiac arrest achieved larger survival gains over time. A substantial reduction in racial differences in survival after in-hospital cardiac arrest has occurred that has been largely mediated by elimination of racial differences in acute resuscitation survival and greater survival improvement at hospitals with a higher proportion of black patients. Further understanding of the mechanisms of this improvement could provide novel insights for the elimination of racial differences in survival for other conditions.

Multivariate Analysis

Population Growth

Health Status Disparities

Humans

Middle Aged

European Continental Ancestry Group - statistics & numerical data

Logistic Models

Male

Survival Rate

Hospitalization

African Americans - statistics & numerical data

Heart Arrest - mortality

Aged, 80 and over

Female

Aged

Cohort Studies

Heart Arrest - therapy

Details

Title: Subtitle: Temporal Changes in the Racial Gap in Survival After In-Hospital Cardiac Arrest
Creators: Lee Joseph - Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
Paul S Chan - Department of Medicine, University of Missouri, Kansas City
Steven M Bradley - Minneapolis Heart Institute, Minneapolis, Minnesota
Yunshu Zhou - Institute for Clinical and Translational Science, University of Iowa, Iowa City
Garth Graham - Department of Medicine, University of Missouri, Kansas City
Philip G Jones - Department of Medicine, University of Missouri, Kansas City
Mary Vaughan-Sarrazin - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
Saket Girotra - Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
Resource Type: Journal article
Publication Details: JAMA cardiology, Vol.2(9), pp.976-984
DOI: 10.1001/jamacardio.2017.2403
PMID: 28793138
PMCID: PMC5710174
NLM abbreviation: JAMA Cardiol
ISSN: 2380-6583
eISSN: 2380-6591
Publisher: United States
Grant note: R01 HL123980 / NHLBI NIH HHS K08 HL122527 / NHLBI NIH HHS
Language: English
Date published: 09/01/2017
Academic Unit: Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
Record Identifier: 9984064197702771

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