Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #116740

Sandro Galea, MD, MPH¹, Shannon Blaney, MPH¹, Monique Kusick¹, Robert Silverman, MD², Neal Richmond, MD³, and David Vlahov, PhD⁴. (1) Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, 212-4193541, sblaney@nyam.org, (2) Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, (3) Office of Medical Affairs, Fire Department of the City of New York, 9 MetroTech Center, Brooklyn, NY 11201, (4) Center for Urban Epidemiologic Studies (CUES), New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029

There is little evidence about the relationship between neighborhood characteristics and survival from out-of-hospital cardiac arrest (OOHCA). We conducted a prospective observational study of consecutive patients within NYC from April 1, 2002-March 31, 2003. Data were collected from prehospital providers by trained paramedics. All OOHCA were geocoded to their neighborhood of residence (n=59). Overall, data was collected on 4653 OOHCA. Citywide OOHCA incidence was 7.6/10,000 adults and survival was 2.9%. Analyses were restricted to 2765 NYC residents with complete data available on all key variables. Survival from OOHCA among persons living in neighborhoods characterized by more unequally distributed income was 1.45%, compared to 2.93% for persons living in neighborhoods characterized by more equitable income distribution (p=0.01); persons living in wealthier neighborhoods had higher survival than those living in less wealthy neighborhoods (2.88% vs. 1.75%, p=0.02). In multivariable logistic models that accounted for demographics (patient age, race/ethnicity, prior cardiac history and functional status), OOHCA event characteristics (witnessed status, CPR receipt, initial cardiac rhythym), and median neighborhood income, living in a high income inequality neighborhood was associated with a lower likelihood of survival (p=0.01) than living in less inequitable neighborhoods. Those living in neighborhoods characterized by income inequality had a 23.2% lower chance of surviving OOHCA than persons living in neighborhoods characterized by one standard deviation more equitably distributed income. This study suggests that quality of the urban residential environment may be associated with OOHCA survival. Further work needs to determine etiologic factors underlying the observed associations.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Describe the likelihood of survival of out-of-hospital cardiac arrest in NYC.
• List the individual-level and neighborhood-level factors that significantly affect the likelihood of survival from out-of-hospital cardiac arrest.
• Recognize the impact of neighborhood-level income inequality on the likelihood of survival by victims of out-of-hospital cardiac arrest within neighborhoods.

Keywords: Measuring Social Inequality, Urban Health

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.