COVID-19 Mortality in California Based on Death Certificates: Disproportionate Impacts Across Racial/Ethnic Groups and Nativity

Sudden Cardiac Arrest During the COVID-19 Pandemic: A Two-Year Prospective Evaluation in a North American Community

BACKGROUND

Early in the COVID-19 pandemic, higher SCA incidence and lower survival rates were reported. However, ongoing effects on SCA during the evolving pandemic have not been evaluated.

OBJECTIVE

We assessed the impact of COVID-19 on SCA during two years of the pandemic.

METHODS

In a prospective study of Ventura County, CA (2020 Pop. 843,843; 44.1% Hispanic), we compared SCA incidence and outcomes during the first two years of the COVID-19 pandemic to the prior four years.

RESULTS

Of 2,222 OHCA cases identified, 907 occurred during the pandemic (March 2020 - Feb 2022) and 1315 occurred pre-pandemic (March 2016 - Feb 2020). Overall age-standardized annual SCA incidence increased from 39/100,000 [95% CI 37-41] pre-pandemic to 54/100,00 [95% CI 50 - 57, p<0.001] during the pandemic. Among Hispanics, incidence increased by 77%, from 38/100,00 [95% CI 34-43] to 68/100,00 [95% CI 60-76, p<0.001]. Among non-Hispanics, incidence increased by 26% from 39/100,000 [95% CI 37-42, p<0.001] to 50/100,00 [95% CI 46-54]. SCA incidence rates closely tracked COVID-19 infection rates. During the pandemic, SCA survival was significantly reduced (15% to 10%, p<0.001) and Hispanics were less likely than non-Hispanics to receive bystander CPR (45% vs. 55%, p=0.005) and present with shockable rhythm (15% vs. 24%, p=0.003).

CONCLUSION

Overall SCA rates remained consistently higher and survival outcomes consistently lower, with exaggerated effects during COVID infection peaks. This longer evaluation uncovered higher increases in SCA incidence among Hispanics, with worse resuscitation profiles. Potential ethnicity-specific barriers to acute SCA care warrant urgent evaluation and intervention.

Ethnicity-Specific Effects on Cardiac Arrest During the COVID-19 Pandemic: A Two-Year Prospective Evaluation in a North American Community

Background

Out-of-hospital sudden cardiac arrest (SCA) is a major public health problem with mortality >90%, and incidence has increased during the COVID-19 pandemic. Information regarding ethnicity-specific effects on SCA incidence and survival is lacking.

Methods

In a prospective, population-based study of Ventura County, CA residents (2020 Pop. 843,843; 44.1% Hispanic), we compared SCA incidence and outcomes during the first two years of the COVID-19 pandemic to the prior four years, overall and by ethnicity (Hispanic vs non-Hispanic).

Findings

Of 2,222 OHCA cases identified, 907 occurred during the pandemic (March 2020 - Feb 2022) and 1315 occurred pre-pandemic (March 2016 - Feb 2020). Overall age-standardized annual SCA incidence increased from 38.9/100,000 [95% CI 36.8-41.0] pre-pandemic to 53.8/100,00 [95% CI 50.3 - 57.3, p<0.001] during the pandemic. Among Hispanics, incidence increased by 77%, from 38.2/100,00 [95% CI 33.8-42.5] to 67.7/100,00 [95% CI 59.5- 75.8, p<0.001]. Among non-Hispanics, incidence increased by 26% from 39.4/100,000 [95% CI 36.9-41.9, p<0.001] to 49.8/100,00 [95% CI 45.8-53.8]. SCA incidence rates closely tracked COVID-19 infection rates. During the pandemic, SCA survival was significantly reduced (15.3% to 10.0%, p<0.001) and Hispanics were less likely than non-Hispanics to have bystander CPR (44.6% vs. 54.7%, p=0.005) and shockable rhythm (15.3% vs. 24.1%, p=0.003).

Interpretation

Hispanic residents experienced higher SCA rates during the pandemic with less favorable resuscitation profiles. These findings implicate potential ethnicity-specific barriers to acute care and represent an urgent call to action at the community and health-system levels.

Funding

National Heart Lung and Blood Institute Grants R01HL145675 and R01HL147358.