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.