Where a person lives in the United States may determine whether they survive a sudden heart stoppage. A new retrospective observational study published in the Journal of the American Heart Association reveals that residential and economic segregation are significant drivers of disparities in survival after out-of-hospital cardiac arrest.
Using a metric called the Index of Concentration at the Extremes to assess segregation, researchers analyzed over 626,000 cardiac arrest cases between 2013 and 2022. They found that patients living in predominantly White, higher-income neighborhoods had a 24 percent higher likelihood of surviving to hospital discharge compared to those in segregated Black and Hispanic/Latinx, lower-income areas.
The disparity extends to long-term quality of life. Residents of privileged areas showed a 20 percent higher rate of survival with good neurological function. Even after controlling for clinical variables like the initial heart rhythm, the association between segregation and survival persisted, suggesting structural factors are at play.
A critical factor influencing these outcomes is the assistance received before emergency responders arrive. The study reports that the likelihood of receiving bystander cardiopulmonary resuscitation (CPR) was 32 percent higher for populations residing in higher-income census tracts. Conversely, there is a “decreasing likelihood of B-CPR being performed in lower income and more highly segregated Black and Hispanic/Latinx census tracts.”
The authors suggest that “areas impacted by residential and economic segregation are important targets for both public policy interventions as well as addressing disparities in care.”
See: “Association of Racial Residential Segregation and Survival After Out-of-Hospital Cardiac Arrest in the United States” (February 19, 2025)
