Association of Combined Community Income and Race/Ethnicity to Antidysrhythmic Administration for Out-of-Hospital Cardiac Arrest.

Background: Little is known about antidysrhythmic administration disparities for out-of-hospital cardiac arrest (OHCA).

Objectives: We evaluated the association between combined lower-income and minoritized communities with antidysrhythmic administration for OHCA.

Methods: We studied the 2018-2021 National Emergency Medical Services Information System encounters, linked to census data. We included adult OHCAs with a shockable rhythm. We used encounter ZIP Code data to calculate household income quartiles (Q1-highest to Q4-lowest). We created combined income and race/ethnicity strata, yielding 6 cohorts and 2 ordered groups (1-4a [Black] and 1-4b [Hispanic] with 1 and 2 shared between them): 1) Q1 income/>70% White, 2) Q2 income/50%-70% White, 3a) Q3 Income/50%-70% Black, 4a) Q4 Income/>70% Black, 3b) Q3 Income/50%-70% Hispanic, and 4b) Q4 income/>70% Hispanic. We evaluated the association of combined income and race/ethnicity groups to administration of an antidysrhythmic, with cohort 1 as the reference.

Results: We included 61,437 OHCAs. Compared to Q1 income/>70% White (33.5%), Q2 income/50-70% White had higher odds of antidysrhythmic administration (36.0%, aOR 1.15 [1.1-1.2]). However, all other groups had lower odds of antidysrhythmic administration (Q3 income/50-70% Black - 28.1%, aOR 0.8 [0.7-0.9]; Q4 income/>70% Black - 29.6%, aOR 0.9 [0.8-0.95]; Q3 income/50-70% Hispanic - 31.1%, aOR 0.9 [0.8-0.99]; Q4 income/>70% Hispanic - 23.0%, aOR 0.6 [0.6-0.7]). Using ordinal regression, decreasing income and increasing Black race (aOR 0.95[0.9-0.97]) as well as decreasing income and increasing Hispanic ethnicity (aOR 0.9 [0.9-0.95]) in a community were associated with decreased odds of antidysrhythmic administration CONCLUSION: Decreasing household income and increasing minoritized race/ethnicity were associated with decreased odds of antidysrhythmic administration.