Explicating Geographical, Racial and Socioeconomic Disparities in Out- of-Hospital Cardiac Arrest in Howard County, MD

Purpose: Geographic, racial and socioeconomic disparities in the incidence and survival rates of out-of-hospital- cardiac arrests (OHCA) have begun to gain attention in the research literature. Addressing this problem will require identifying disparities and developing effective solutions. The purpose of this retrospective observational study was to analyze and compare OHCA prevalence and survival rates among different racial and SES groups in cities in Howard County, MD.

Method: Data was obtained for two fiscal years (n=236, 2011 and 2012) from the ambulance computer aided dispatch system. Reports were matched with poverty levels and racial distributions according to 2012 data from the Census Bureau.

Results: Cities with the highest OHCA prevalence were Ellicott City (31.9%), Columbia (25.86%), Elkridge (8.62%), and Laurel (8.19%)—(p<.0001). Fulton had the highest stratified survival rate at (66.7%), followed by Marriottsville (40%), and Dayton (33%)—(p=.011); survival rates were zero in Clarksville, Woodbine, and Woodstock. Cities with the highest stratified bystander CPR (with at least one survival) were Jessup (73%), Ellicott City (62%), and Fulton (33%)—(p=.044). An inverse correlation was observed between poverty and ambulance duration to an OHCA scene (r=-0.30, p<.0001). Survival by race was 12% for Whites, 9% for Blacks, and 0% for Asians (p=.49).

Conclusion: This analysis demonstrates that variations in OHCA prevalence and survival exist in Howard County. Bystander CPR does contribute to survival in narrowing the disparity gap. Cities with no or low survival rate may benefit from community CPR and/or AED programs to ensure early external defibrillation is accomplished.