Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries

Ethan E. Abbott, David G. Buckler, Jesse Y. Hsu, Benjamin S. Abella, Lynne D. Richardson, Brendan G. Carr, Alexis M. Zebrowski

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish
Article numbere030138
JournalJournal of the American Heart Association
Volume12
Issue number19
DOIs
StatePublished - 2023

Keywords

  • health disparities
  • long-term outcomes
  • out-of-hospital cardiac arrest
  • racial residential segregation

Fingerprint

Dive into the research topics of 'Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries'. Together they form a unique fingerprint.

Cite this