Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Race and Survival After Cardiac Arrest

Race and Survival After Cardiac Arrest To the Editor: In their cohort study, Dr Chan and colleagues1 examined the disparity in outcomes after in-hospital cardiac arrest on the basis of race. Reduced survival to hospital discharge for black patients was associated with lower rates of resuscitation and postresuscitation survival. Although 93% of the postresuscitation outcome difference is explained by hospital center effects and clinical characteristics, these features only explain half the difference in resuscitation rate. Clinician bias could affect resuscitation rate if efforts were less aggressive or prematurely terminated on the basis of race. The authors note delayed time to defibrillation in black patients in this and a prior study,2 but most of this effect was due to black patients being in hospital centers in which delays are more likely. Furthermore the number of defibrillations and duration of resuscitation for the entire cohort were similar between races, suggesting similar resuscitation aggressiveness. If clinician racial bias were an important contributor to the resuscitation rate disparity, this effect would be expected to be most pronounced in centers in which racial discordance between health care workers and patients is maximal. Although black patients make up nearly 13% of the US population,3 they are underrepresented as clinicians, with the highest proportion of minority health care workers concentrated in centers serving mostly minorities.4 The largest disparity in survival between black and white patients occurred in the 50 hospitals in which black patients accounted for only 3.4% of cardiac arrests and racial discordance between mostly white health care workers and black patients was likely greatest. We wonder whether the measures of resuscitation aggressiveness are similar between races when stratified by the quintiles of survival defined by the authors, which in effect stratify hospitals to those with very small and very large black patient populations. We are concerned that black patients had worse survival at the top tier hospitals (in which overall survival was 41.2%) compared with middle tier hospitals (in which survival was only 35.7%), yet they were not underrepresented relative to the general population. The authors have done a thorough search for explanations for their findings within the limitations of the National Registry of Cardiopulmonary Resuscitation database. Hospital effects and clinical characteristics provide substantial explanation for racial disparities in resuscitation rate but do not fully address the dilemma of maximal racial disparities at centers with optimum outcomes. Back to top Article Information Financial Disclosures: None reported. References 1. Chan PS, Nichol G, Krumholz HM, et al; American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) Investigators. Racial differences in survival after in-hospital cardiac arrest. JAMA. 2009;302(11):1195-120119755698PubMedGoogle ScholarCrossref 2. Chan PS, Krumholz HM, Nichol G, Nallamothu BK.American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med. 2008;358(1):9-1718172170PubMedGoogle ScholarCrossref 3. US Census Bureau Web site. American FactFinder: 2008 population estimates, detailed tables (Table 3). http://factfinder.census.gov. Accessed October 15, 2009 4. Dionne MG. The United States health workforce profile. Cah Sociol Demogr Med. 2006;46(2):221-25216886717PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Race and Survival After Cardiac Arrest

JAMA , Volume 303 (2) – Jan 13, 2010

Loading next page...
 
/lp/american-medical-association/race-and-survival-after-cardiac-arrest-0AQjK05Qzj

References (4)

Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2009.1966
Publisher site
See Article on Publisher Site

Abstract

To the Editor: In their cohort study, Dr Chan and colleagues1 examined the disparity in outcomes after in-hospital cardiac arrest on the basis of race. Reduced survival to hospital discharge for black patients was associated with lower rates of resuscitation and postresuscitation survival. Although 93% of the postresuscitation outcome difference is explained by hospital center effects and clinical characteristics, these features only explain half the difference in resuscitation rate. Clinician bias could affect resuscitation rate if efforts were less aggressive or prematurely terminated on the basis of race. The authors note delayed time to defibrillation in black patients in this and a prior study,2 but most of this effect was due to black patients being in hospital centers in which delays are more likely. Furthermore the number of defibrillations and duration of resuscitation for the entire cohort were similar between races, suggesting similar resuscitation aggressiveness. If clinician racial bias were an important contributor to the resuscitation rate disparity, this effect would be expected to be most pronounced in centers in which racial discordance between health care workers and patients is maximal. Although black patients make up nearly 13% of the US population,3 they are underrepresented as clinicians, with the highest proportion of minority health care workers concentrated in centers serving mostly minorities.4 The largest disparity in survival between black and white patients occurred in the 50 hospitals in which black patients accounted for only 3.4% of cardiac arrests and racial discordance between mostly white health care workers and black patients was likely greatest. We wonder whether the measures of resuscitation aggressiveness are similar between races when stratified by the quintiles of survival defined by the authors, which in effect stratify hospitals to those with very small and very large black patient populations. We are concerned that black patients had worse survival at the top tier hospitals (in which overall survival was 41.2%) compared with middle tier hospitals (in which survival was only 35.7%), yet they were not underrepresented relative to the general population. The authors have done a thorough search for explanations for their findings within the limitations of the National Registry of Cardiopulmonary Resuscitation database. Hospital effects and clinical characteristics provide substantial explanation for racial disparities in resuscitation rate but do not fully address the dilemma of maximal racial disparities at centers with optimum outcomes. Back to top Article Information Financial Disclosures: None reported. References 1. Chan PS, Nichol G, Krumholz HM, et al; American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) Investigators. Racial differences in survival after in-hospital cardiac arrest. JAMA. 2009;302(11):1195-120119755698PubMedGoogle ScholarCrossref 2. Chan PS, Krumholz HM, Nichol G, Nallamothu BK.American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med. 2008;358(1):9-1718172170PubMedGoogle ScholarCrossref 3. US Census Bureau Web site. American FactFinder: 2008 population estimates, detailed tables (Table 3). http://factfinder.census.gov. Accessed October 15, 2009 4. Dionne MG. The United States health workforce profile. Cah Sociol Demogr Med. 2006;46(2):221-25216886717PubMedGoogle Scholar

Journal

JAMAAmerican Medical Association

Published: Jan 13, 2010

There are no references for this article.