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Introduction: The association between sudden unexpected death in infancy (SUDI) and low socio-economic status has been well described in the literature. While the rate of SUDI had declined dramatically following successful campaigns that promoted safe sleeping habits, it has remained stable over the past decade and increasingly been confined to the most socially disadvantaged and vulnerable families. Racial and ethnic disparities persist. Despite extensive research associating the multitude of societal level factors associated with social and economic disadvantage and the increased risk of SUDI, their mechanisms on SUDI remain poorly understood. Hypothesis: A novel composite multi-dimensional marker of neighborhood-level disadvantage may be used to evaluate the association between SUDI and neighborhood-level disadvantages in the City of Chicago. Methods: Sudden unexpected death in infancy cases were identified from the Cardiac Arrest Registry to Enhance Survival database. The composite neighborhood-level disadvantage index was derived using an explanatory factor analysis of the social economic factors recorded in the 2015 American Community Survey of the 77 community areas of the City of Chicago. We defined 3 levels of disadvantage: high, medium, and low. A geographic information system, was used to map the community areas’ disadvantage level and individual SUDI cases. Results: Ninety-one SUDI cases were identified. Non-Hispanic Black (64/91(70%)) and Hispanic (16/91 (18%)) comprised the majority of SUDI cases. Sudden unexpected death in infancy cases were highly concentrated in disadvantaged areas. Eighty-six cases (94.5%) occurred in high and medium disadvantaged areas while 5 cases (5.5%) occurred in the low and no disadvantaged areas (P < 0.0001). Finally, SUDI cases from high and medium disadvantaged areas had a lower hospital admission rate when compared to those from the low and no disadvantaged areas (OR 0.04). Conclusions: The study confirms the persistent racial and socio-economic disparities in SUDI in the City of Chicago. The study’s use of a multi-dimensional composite index of neighborhood-level disadvantage and domestic violence would serve as the basis for further analyses and potential social intervention programs.

Introduction: Approximately 1,000 out-of-hospital cardiac arrest (OHCA) occur per day in the United States. Although survival rates remains low, the extent to which OHCA neurological outcomes differ between men and women remains poorly characterized. Methods: Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 195,722 adult individuals with an OHCA between 2013-2017. Using multi-variable logistic regression models, we evaluated for sex differences in rates of survival to hospital discharge and favorable neurological outcome (survival with discharge CPC score of 1 or 2), adjusted for cardiac arrest characteristics, race, location, year of arrest, age, and use of targeted temperature management (TTM) and coronary angiography. Results: Overall, 70,767 (31%) patients were women. Median age was 64 and 62 years for women and men, respectively. An initial shockable rhythm (14.9% vs. 25.7%) and a witnessed arrest (40.9% vs. 45.6%) was more common in men. Bystander CPR was provided to 37% of women and 39% of men. Men were less likely to survive to hospital discharge than women (8.7% vs. 10.9%; adjusted OR 0.75, 95% CI 0.73, 0.78). Similarly, men were less likely to have favorable neurological outcome (6.6% vs. 9.2% for women; adjusted OR 0.78, 95% CI 0.74, 0.82). Further interaction analysis for the pre-hospital elements found small, but statistically significant sex differences in favorable neurological survival for witnessed status (among female OR 2.29, 95% CI 2.10, 2.49; among males OR 2.07, 95% CI 1.92, 2.23, p= 0.04) and for bystander CPR (among females OR 1.20, 95% CI 1.11, 1.29; among males OR 1.34, 95% CI 1.27, 1.42, p= 0.01). Interaction of sex with the hospital level variables of TTM and coronary angiography, for the subset of patients that survived to hospital admission, had no sex differences in favorable neurological outcome. Conclusion: Our analysis shows that for OHCA in the United States, women have better survival outcomes than men. There was a sex differences in the pre-hospital variable of BCPR, but not in the other modifiable variables of TTM and coronary angiography. Further study is needed to better understand sex differences in overall survival and neurological outcomes.