Disparities in Pediatric Out-of-Hospital Cardiac Arrest Outcomes Relating to Race, Urbanicity, and Poverty: A Study of the NEMSIS Database

Prehosp Emerg Care. 2026 Jul 1:1-14. doi: 10.1080/10903127.2026.2695249. Online ahead of print.

ABSTRACT

OBJECTIVES: Sociodemographic disparities exist in out-of-hospital cardiac arrest (OHCA) outcomes among adults, though less is known regarding social drivers of OHCA outcomes among children. Our objective was to evaluate for sociodemographic disparities in prehospital pediatric OHCA (POHCA) outcomes using a nationwide database.

METHODS: This observational cross-sectional study utilized the National Emergency Medical Services Information System (NEMSIS) Database to obtain nationwide POHCA data from 2021-2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), bystander automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). Patient demographic data included age, sex, and race/ethnicity. Patient home population-based geographic categories (urban, suburban, rural/frontier) and community poverty levels were obtained from the United States Census Bureau. Multivariable logistic regression was used to assess for associations between sociodemographic factors and prehospital POHCA outcomes.

RESULTS: Among the 14,783 POHCAs, 56.2% received bystander CPR, 20.7% bystander AED usage, and 21.2% ROSC achievement. When compared to White children, Black children were less likely to receive bystander CPR [OR 0.72 (95%CI 0.66-0.80)] and achieve ROSC [OR 0.71 (95%CI 0.63-0.80)]. Hispanic children were less likely to receive bystander CPR [OR 0.73 (96%CI 0.65-0.82)] and bystander AED usage [OR 0.77 (95%CI 0.66-0.89)], though there was no significant association with a difference in ROSC achievement. When compared to children from urban areas, children from rural [OR 1.24 (95%CI 1.08-1.42)] and suburban areas [OR 1.21 (95%CI 1.03-1.42)] were more likely to receive bystander CPR. When compared to communities with moderate poverty levels, communities with the lowest poverty levels were associated with significantly increased bystander CPR [OR 1.31 (95%CI 1.11-1.54)] and AED usage [OR 1.46 (95%CI 1.22-1.75)], while high community poverty levels were associated with decreased bystander CPR [OR 0.78 (95%CI 0.69-0.89)], bystander AED usage [OR 0.74 (95%CI 0.63-0.87)], and ROSC [OR 0.76 (95%CI 0.65-0.90)].

CONCLUSIONS: Bystander cardiopulmonary interventions occur least often for children of racial/ethnic minorities and children residing in urban and resourced-limited settings. The lowest ROSC rates occur amongst Black children and children from the most impoverished communities. Further studies are needed to understand these complex health disparities, such that public health interventions can better promote equitable outcomes for all children.

PMID:42385018 | DOI:10.1080/10903127.2026.2695249