CONTEXT: Racial differences in survival have not been previously studied after in-hospital cardiac arrest, an event for which access to care is not likely to influence treatment. OBJECTIVES: To estimate racial differences in survival for patients with in-hospital cardiac arrests and examine the association of sociodemographic and clinical factors and the admitting hospital with racial differences in survival. DESIGN, SETTING, AND PATIENTS: Cohort study of 10,011 patients with cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia enrolled between January 1, 2000, and February 29, 2008, at 274 hospitals within the National Registry of Cardiopulmonary Resuscitation. MAIN OUTCOME MEASURES: Survival to hospital discharge; successful resuscitation from initial arrest and postresuscitation survival (secondary outcome measures). RESULTS: Included were 1883 black patients (18.8%) and 8128 white patients (81.2%). Rates of survival to discharge were lower for black patients (25.2%) than for white patients (37.4%) (unadjusted relative rate [RR], 0.73; 95% confidence interval [CI], 0.67-0.79). Unadjusted racial differences narrowed after adjusting for patient characteristics (adjusted RR, 0.81 [95% CI, 0.75-0.88]; P < .001) and diminished further after additional adjustment for hospital site (adjusted RR, 0.89 [95% CI, 0.82-0.96]; P = .002). Lower rates of survival to discharge for blacks reflected lower rates of both successful resuscitation (55.8% vs 67.4% for whites; unadjusted RR, 0.84 [95% CI, 0.81-0.88]) and postresuscitation survival (45.2% vs 55.5% for whites; unadjusted RR, 0.85 [95% CI, 0.79-0.91]). Adjustment for the hospital site at which patients received care explained a substantial portion of the racial differences in successful resuscitation (adjusted RR, 0.92 [95% CI, 0.88-0.96]; P < .001) and eliminated the racial differences in postresuscitation survival (adjusted RR, 0.99 [95% CI, 0.92-1.06]; P = .68). CONCLUSIONS: Black patients with in-hospital cardiac arrest were significantly less likely to survive to discharge than white patients, with lower rates of survival during both the immediate resuscitation and postresuscitation periods. Much of the racial difference was associated with the hospital center in which black patients received care.
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机译：语境：院内心脏骤停后，尚未对生存的种族差异进行过研究，这一事件的获得护理不太可能影响治疗。目的：评估住院心脏骤停患者的种族差异，并研究社会人口统计学和临床因素与入院医院与种族差异的关系。设计，地点和患者：2000年1月1日至2008年2月29日期间在美国国家心肺复苏中心内的274家医院进行的队列研究，研究对象为10,011例因室颤或无脉搏动性心动过速而导致心脏骤停的患者。主要观察指标：出院后生存;从最初的逮捕和复苏后的生存中获得成功的复苏（次要结局指标）。结果：包括1883黑人患者（18.8％）和8128白人患者（81.2％）。黑人患者（25.2％）的出院生存率低于白人患者（37.4％）（未调整相对率[RR]为0.73; 95％置信区间[CI]为0.67-0.79）。调整患者特征后，未调整的种族差异变窄（调整后的RR，0.81 [95％CI，0.75-0.88]; P <.001），并在进一步调整医院部位后减少了（调整后的RR，0.89 [95％CI，0.82-] 0.96]; P = .002）。黑人的出院生存率较低反映了成功复苏的成功率（白人为55.8％，白人为67.4％;未调整的RR为0.84 [95％CI，0.81-0.88]）和复苏后的生存率较低（白人为45.2％，而55.5％）。未经调整的RR，0.85 [95％CI，0.79-0.91]。对患者接受治疗的医院地点的调整解释了成功复苏中种族差异的很大一部分（调整后的RR为0.92 [95％CI，0.88-0.96]; P <.001），并消除了复苏后生存的种族差异（调整后的RR，0.99 [95％CI，0.92-1.06]; P = 0.68）。结论：院内心脏骤停的黑人患者比白人患者存活存活的可能性明显降低，在立即复苏和复苏后期间的存活率较低。种族差异大部分与黑人患者接受护理的医院中心有关。
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