Social determinants of health and their associations with outcomes in pediatric out-of-hospital cardiac arrest: A national study of the NEMSIS database

Background: Social determinants of health (SDOH) impact health disparities, though little is known about the effects of SDOH on pediatric out-of-hospital cardiac arrest (POHCA).

Methods: This cross-sectional study utilized the NEMSIS Database to obtain nationwide POHCA data from 2021 to 2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). SDOH data was obtained from the US Census Bureau and included minority race/ethnicities status, poverty levels, and educational attainment of the community where POCHAs occurred. Multivariable logistic regression and Cochran-Armitage trend tests were used to assess associations between SDOH and POHCA outcomes.

Results: Query of the NEMSIS Database yielded 27,137 POHCAs. The odds of CPR performance and obtainment of ROSC were significantly higher (p < 0.001) in communities with lower levels of minority races/ethnicities. The odds of bystander CPR, AED usage, and obtainment of ROSC all increased significantly (p < 0.001) in the wealthiest communities compared to the poorest communities. The odds of bystander AED usage (p = 0.001) and ROSC (p = 0.003) were significantly higher in communities with the highest educational attainment. As the minority status and poverty level of the community increased and educational attainment decreased, there was a significant decreasing trend (p < 0.001) in performance of bystander CPR, AED usage, and obtainment of ROSC.

Conclusions: Community-level SDOH, including increasing community minority status, poverty levels, and decreasing educational attainment, are associated with less bystander CPR, AED usage, and ROSC obtainment in POHCAs. Understanding SDOH offers opportunities for public health interventions addressing disparities in POHCA outcomes.