Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries.
J Am Heart Assoc
; 12(19): e030138, 2023 10 03.
Article
in En
| MEDLINE
| ID: mdl-37750559
ABSTRACT
Background The national impact of racial residential segregation on out-of-hospital cardiac arrest outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long-term survival and readmissions after out-of-hospital cardiac arrest among Medicare beneficiaries. Methods and Results In this retrospective cohort study, using Medicare claims data, our primary predictor was the index of concentration at the extremes, a measure of racial and economic segregation. The primary outcomes were death up to 3 years and readmissions. We estimated hazard ratios (HRs) across all 3 types of index of concentration at the extremes measures for each outcome while adjusting for beneficiary demographics, treating hospital characteristics, and index hospital procedures. In fully adjusted models for long-term survival, we found a decreased hazard of death and risk of readmission for beneficiaries residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes across all 3 indices of concentration at the extremes measures (race HR, 0.87 [95% CI, 0.81-0.93]; income HR, 0.75 [95% CI, 0.69-0.78]; and race+income HR, 0.77 [95% CI, 0.72-0.82]). Conclusions We found a decreased hazard of death and risk for readmission for those residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes when using validated measures of racial and economic segregation. Although causal pathways and mechanisms remain unclear, disparities in outcomes after out-of-hospital cardiac arrest are associated with the structural components of race and wealth and persist up to 3 years after discharge.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Patient Readmission
/
Out-of-Hospital Cardiac Arrest
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Equity_inequality
Limits:
Aged
/
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
J Am Heart Assoc
Year:
2023
Document type:
Article