Abstract 12704: Racial, Ethnic, and Socioeconomic Disparities in Incidence and Survival for Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival (CARES)

Introduction: Racial, ethnic, and socioeconomic disparities in pediatric out-of-hospital cardiac arrest (OHCA) exist; however, pediatric OHCA incidence and survival outcomes among race, ethnicity, and socioeconomic status (SES) are unknown. We evaluated the incidence and outcomes of pediatric OHCA among race, ethnicity, and SES, hypothesizing that Black and Hispanic children, and children from a lower SES, would have higher incidence rates and lower survival compared to White children.

Methods: We conducted a retrospective cohort study using the Cardiac Arrest Registry to Enhance Survival database, analyzing nontraumatic OHCAs in children<18 years old between 2015 and 2019. A previously validated SES risk score, incorporating race, ethnicity, household income, high school graduation rates, and unemployment rates, was developed on a scale from 0-4, with 4 indicating the highest-risk neighborhood.

Results: Among 6945 OHCAs, 33% occurred in Black children, 11% in Hispanic children, 31% in White children, and 41% in the highest-risk neighborhood. Black children had the highest OHCA incidence (15.5 per 100,000 children) compared to White children (3.8 per 100,000 children) and Hispanic children (3.3 per 100,000 children) (p<0.001). OHCA incidence was higher in high-risk neighborhoods (11.6 per 100,000) compared to low-risk neighborhoods (4.3 per 100,000) (p<0.001). In multivariable analysis, Black children had lower odds of survival to hospital discharge (aOR 0.74, CI 0.59-0.92) and neurologically favorable survival (aOR 0.64, CI 0.50-0.82) compared to White children. Hispanic children did not have significantly worse survival outcomes compared to White children. Children from the lowest-risk neighborhoods had higher odds of survival to hospital discharge (aOR 1.45, CI 1.12-1.87) and neurologically favorable survival (aOR 1.65, CI 1.24-2.20) compared to children from the highest-risk neighborhoods.

Conclusions: Significant racial, ethnic, and socioeconomic disparities exist in pediatric OHCA. Black children have over four times the incidence of OHCA compared to White and Hispanic children and significantly worse survival outcomes. Children from low-risk neighborhoods have significantly better survival outcomes.