Abstract Details

Title The Impact of Socioeconomic Status on Risk for Brain Death Following Out-of-Hospital Cardiac Arrest

Topic Health Care Disparities

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-014

Objective Evaluate the impact of socioeconomic status (SES) on the risk for brain death following out-of-hospital cardiac arrest (OHCA).

Background Lower SES has been associated with worse survival and lower likelihood for good neurologic outcomes following OHCA 1-3, however, less is known about the impact of SES on the occurrence of brain death.

Design/Methods This is a retrospective review of consecutive comatose OHCA patients admitted to a single US tertiary care center between 2014-2022. The Distressed Communities Index (DCI) was used to determine SES. High SES included prosperous and comfortable; low-middle SES included mid-tier, at risk, and distressed groups. We conducted logistic regression analyses to test the association between SES and brain death.

Results Of 545 OHCA patients, 350 (64%) were identified as low-middle SES. Low-middle SES patients were more likely to present younger (mean (SD) 57.4 (16.2) vs. 61.4 (16.9) years, p=0.006), identify as Black (38.6% vs. 4.3%) and Hispanic (15.5% vs. 3.1%). There was no difference in premorbid disability (Charlson comorbidity index 3.4 (2.9) vs. 3.3 (2.8), p=0.645). Low-middle SES patients presented with less favorable arrest characteristics (26.3% vs. 39.2% shockable rhythm, p= 0.003; initial lactate 9.9 (4.5) vs. 8.5 (4.3), p= 0.001, Pittsburgh Cardiac Arrest Category 3.4 (0.9) vs. 3.1 (1.1), p= 0.002), despite similar rates of bystander cardiopulmonary resuscitation (44.6% vs. 51.8%, p=0.126). Brain death was more common in patients with low-middle SES (14.9% vs. 8.2%, p=0.034). There was no difference in time to withdrawal of life sustaining therapy (median [interquartile range] 5 [2,9] days vs. 4 [2,7] days, p=0.118).

Conclusions Brain death, following OHCA, occurs more frequently in patients with low to middle SES compared to high SES. Further work is needed to understand drivers of this disparity.

Authors/Disclosures
Celia Fung, MD (Yale New Haven Hospital) PRESENTER	Dr. Fung has nothing to disclose.
Eva Kitlen	No disclosure on file
Christine Nguyen	Miss Nguyen has nothing to disclose.
Noah Kim	No disclosure on file
Charles Wira	Charles Wira has nothing to disclose.
Sarah Perman (Yale School of Medicine)	Sarah Perman has received research support from National Institutes of Health.
Akhil Khosla	Akhil Khosla has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Inari.
P Elliott Miller	P Elliott Miller has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JCF-I.
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. An immediate family member of Dr. Greer has or had stock in Vertex Pharmaceuticals. The institution of Dr. Greer has received research support from NINDS. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to AAN interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to AAN interests or activities.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
Rachel Beekman, MD (Yale New Haven Medical Center)	Dr. Beekman has nothing to disclose.

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