title: Racial disparities in outcomes following PEA and asystole in-hospital cardiac arrests.
abstract: OBJECTIVE
  To define the racial differences present after PEA and asystolic IHCA and explore factors that could contribute to this disparity.
  
  
  METHODS
  We analyzed PEA and asystolic IHCA in the Get-With-The-Guidelines-Resuscitation database. Multilevel conditional fixed effects logistic regression models were used to estimate the relationship between race and survival to discharge and return of spontaneous circulation (ROSC), sequentially controlling for hospital, patient demographics, comorbidities, arrest characteristic, process measures, and interventions in place at time of arrest.
  
  
  RESULTS
  Among the 561 hospitals, there were 76,835 patients who experienced IHCA with an initial rhythm of PEA or asystole (74.8% white, 25.2% black). Unadjusted ROSC rate was 55.1% for white patients and 54.1% for black patients (unadjusted OR: 0.94 [95% CI, 0.90-0.98], p=0.016). Survival to discharge was 12.8% for white patients and 10.4% for black patients (unadjusted OR: 0.83 [95% CI, 0.78-0.87], p<0.001). After adjusting for temporal trends, patient characteristics, hospital, and arrest characteristics, there remained a difference in survival to discharge (OR: 0.85 [95% CI, 0.79-0.92]) and rate of ROSC (OR: 0.88 [95% CI, 0.84-0.92]). Black patients had a worse mental status at discharge after survival. Rates of DNAR placed after survival from were lower in black patients with a rate of 38.3% compared to 44.5% in white patients (p<0.001).
  
  
  CONCLUSIONS
  Black patients are less likely to experience ROSC and survival to discharge after PEA or asystole IHCA. Individual patient characteristics, event characteristics, and hospital characteristics don't fully explain this disparity. It is possible that disease burden and end-of-life preferences contribute to the racial disparity.
authors.affiliation: Department of Cardiology, Kaiser Los Angeles Medical Center, Los Angeles, CA, United States.
authors.forename: Rabia R
authors.initials: RR
authors.lastname: Razi
authors.affiliation: Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, United States; Department of Health Studies, University of Chicago, Chicago, IL, United States.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Churpek
authors.affiliation: Section of Hospital Medicine, University of Chicago, Chicago, IL, United States.
authors.forename: Trevor C
authors.initials: TC
authors.lastname: Yuen
authors.affiliation: Section of General Internal Medicine, University of Chicago, Chicago, IL, United States.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Peek
authors.affiliation: Health Care Service Corporation, Chicago, IL, United States.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fisher
authors.affiliation: Section of Hospital Medicine, University of Chicago, Chicago, IL, United States. Electronic address: dperes@uchicago.edu.
authors.forename: Dana P
authors.initials: DP
authors.lastname: Edelson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000706:statistics & numerical data; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D054624:Health Status Disparities; D006323:Heart Arrest / Q000208:ethnology / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D058996:Quality Improvement; D012042:Registries; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
keywords: Cardiopulmonary resuscitation; Chest compression; Defibrillation; Heart arrest; Racial disparity