Effect of County Poverty Ratio on ROSC in OHCA: A Statewide Analysis

Introduction—It is well established that factors such as age, race, gender, urbanicity, and socioeconomic status affect survival in out-of-hospital cardiac arrest (OHCA). However, extant research has not studied the effect of a locale’s poverty ratio on the return of spontaneous circulation (ROSC) in OHCA.

Objective—To examine the effect of county poverty ratio on the likelihood of achieving ROSC in OHCA for a mixed urban, suburban, and rural state.

Methods—A retrospective study of OHCA was conducted using a statewide EMS patient database. All adult, nontraumatic arrests in North Carolina between Jan. 1, 2012, and June 30, 2014, were included. Data from the U.S. Census Bureau’s Small Area Income and Poverty Estimates (SAIPE) program were used to determine the 2012 poverty rate for each of North Carolina’s 100 counties. A logistic regression model was then used to quantify the influence of poverty ratio on ROSC while controlling for other patient demographics and EMS response variables.

Results—A total of 7,280 patients met inclusion criteria. Overall ROSC was achieved in 2,810 (39%) patients. For every 1% increase in the poverty rate, patients were 4.1% less likely to achieve ROSC (OR 0.959, p<0.001). Male patients were 29% less likely to achieve ROSC (OR 0.71, p<0.01). Additionally, for every minute increase in EMS response time, ROSC was 2.9% less likely to be achieved (OR 0.971, p<0.01). ROSC was more likely achieved by receiving lay person or first responder CPR prior to EMS arrival (OR 1.29, p<0.001), in arrests witnessed by a bystander (OR 2.40, p<0.001) or healthcare provider (OR 2.70, p<0.001), and with an initial shockable rhythm (OR 1.29, p<0.001). Age (OR 1.001, p=0.702) and minority status (OR 0.894, p=0.053) were not significant predictors.

Conclusion—In this retrospective analysis, patients were more likely to achieve ROSC based on their county’s poverty ratio, gender, receipt of CPR prior to EMS arrival, witnessed arrest, and initial shockable rhythm. Further study of this relationship in a variety of geographical settings is needed to better understand potential inequities of ROSC achievement.