Socio-economic differences in incidence, bystander cardiopulmonary resuscitation and survival from out-of-hospital cardiac arrest: A systematic review

Nieuwenhuizen, Benjamin P. van; Oving, Iris; Kunst, Anton E.; Daams, Joost G.; Blom, Marieke T.; Tan, Hanno L.; Valkengoed, Irene G. M. van

doi:10.1016/j.resuscitation.2019.05.018

Cited by 68 publications

(92 citation statements)

References 76 publications

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“…Several studies have investigated socioeconomic status (SES) impact on various aspects of OHCA. 3,4,14,15 These have in general focused on prehospital factors like bystander CPR and on outcome. The finding that low SES is associated with worse outcomes have been explained by e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies (as well as ours) have reported a lower rate of bystander CPR and discussed about poorer CPR quality in areas with low SES. 4 It is thus likely that a higher proportion of patients with low SES with cardiac cause and shockable ECG rhythm immediately after the arrest, has a non-shockable ECG rhythm upon arrival of prehospital personnel. These patients might be mistaken as having a low risk of a coronary artery cause for the cardiac arrest due to the false assumption that initial ECG rhythm was non-shockable.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Several studies have shown worse outcomes after OHCA in patients with low socioeconomic status. 3,4 This has mainly been attributed to factors outside the reach of the healthcare system caring for the patient after the arrest, e.g. lower rates of bystander CPR and more complex comorbidities.…”

Section: Introductionmentioning

confidence: 99%

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Income is associated with the probability to receive early coronary angiography after out-of-hospital cardiac arrest

et al. 2020

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Introduction: Low socioeconomic status has been associated with worse outcome after cardiac arrest. This study aims to investigate if patientsincome influences the probability to receive early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients. Methods: In this nationwide retrospective observational study, 3906 OHCA patients admitted alive and registered in the Swedish Registry for Cardiopulmonary Resuscitation were included. Individual data on income and educational level, prehospital parameters, coronary angiography results and comorbidity were linked from SWEDEHEART and other national registers. Results: Patients were divided into quarters depending on their income level. In the unadjusted model there was a strong correlation between income level and rate of early coronary angiography where 35.5% of patients in the highest income quarters received early angiography compared to 15.4% in the lowest income quarters. When adjusting for educational level, sex, age, comorbidity and hospital type, there were still higher chance of receiving early coronary angiography with increasing income, OR 1.31 (CI 1.01À1.68) and 1.67 (CI 1.29À2.16) for the two highest income quarters respectively compared to the lowest income quarter. When adding potential mediators to the model (first recorded ECG rhythm by the EMS, location, response time, bystander cardiopulmonary resuscitation and if the arrest was witnessed) no difference in early angiography related to income level where found. The main mediator was first recorded ECG rhythm. Conclusion: Income level is associated with the probability to undergo early coronary angiography in OHCA patients. This association seems to be mediated by the initial ECG rhythm.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Income is associated with the probability to receive early coronary angiography after out-of-hospital cardiac arrest

et al. 2020

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“…OHCAs occurring in different areas might impact the EMS response time, and might re ect different socioeconomic status of the countries [3,10]. Shorter response time, younger age, OHCA occurring during the daytime, urban areas, and socioeconomic status are usually associated with better prognosis [15,16,24,25]. However, people who have OHCAs in public locations tend to be healthier, are able to move freely, and probably have less comorbidity, and thus have better outcomes [26].…”

Section: Discussionmentioning

confidence: 99%

Association Between Modifiable Prehospital Prognostic Factors on Out-Of-Hospital Cardiac Arrest in Different Age Groups

Huang

Lee

et al. 2020

Preprint

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Background The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor. While several prehospital factors are known to be associated with improved survival, the impact of prehospital factors on different age groups is unclear. The objective of the study was to access the impact of prehospital factors and pre-existing comorbidities on OHCA outcomes in different age groupsMethods A retrospective observational analysis was conducted using the emergency medical service (EMS) database from January 2015 to December 2019. We collected information on prehospital factors, underlying diseases, and outcome of OHCAs in different age groups. Kaplan-Meier type survival curves and multivariable logistic regression were used to analyze the association between modifiable pre-hospital factors and outcomes. Results A total of 4188 witnessed adult OHCAs were analyzed. For the younger group (age ≦75 years old), after adjustment for confounding factors, EMS response time (odds ratio [OR]=0.860, 95% confidence interval [CI]: 0.811-0.909, p<0.001), public location (OR=1.843, 95% CI: 1.179-1.761, p<0.001), bystander CPR (OR=1.329, 95% CI: 1.007-1.750, p=0.045), attendance by an EMT-Paramedic (OR=1.666, 95% CI: 1.277-2.168, p<0.001), and prehospital defibrillation by automated external defibrillator (AED)(OR=1.666, 95% CI: 1.277-2.168, p<0.001) were prognostic factors for OHCA. For the older group (age >75 years old), age (OR=0.924, CI: 0.880-0.966, p=0.001), EMS response time (OR=0.833, 95% CI: 0.742-0.928, p=0.001), public location (OR=4.290, 95% CI: 2.450-7.343, p<0.001), and attendance by an EMT-Paramedic (OR=2.702, 95% CI: 1.704-4.279, p<0.001) were independent prognostic factors for OHCA.Conclusions There were variations between younger and older OHCA patients. We found that bystander CPR and prehospital defibrillation by AED were independent prognostic factors for younger OHCA patients but not for the older group.

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“… 13 In a recent review, these results were corroborated, and it was concluded that low SES areas generally showed a higher incidence of OHCA. 14 It is important to further identify factors that lead to a high incidence of OHCA in order to be able to guide health interventions such as placement of public automated external defibrillators (AEDs) and to improve cardiopulmonary resuscitation (CPR) skills in those high-risk areas.…”

Section: Introductionmentioning

confidence: 99%

Relationship between socioeconomic status and incidence of out-of-hospital cardiac arrest is dependent on age

Jonsson

Ljungman

Härkönen

et al. 2020

J Epidemiol Community Health

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BackgroundThe association between socioeconomic status (SES) and incidence of out-of-hospital cardiac arrest (OHCA) is not fully understood. The aim of this study was to see if area-level socioeconomic differences, measured in terms of area-level income and education, are associated with the incidence of OHCA, and if this relationship is dependent on age.MethodsWe included OHCAs that occurred in Stockholm County between the 1st of January 2006 and the 31st of December 2017, the victims being confirmed residents (n=10 574). We linked the home address to a matching neighbourhood (base unit) via available socioeconomic and demographic information. Socioeconomic variables and incidence rates were assessed by using cross-sectional values at the end of each year. We used zero-inflated negative binomial regression to calculate incidence rate ratios (IRRs).ResultsAmong 1349 areas with complete SES information, 10 503 OHCAs occurred between 2006 and 2017. The IRR in the highest versus the lowest SES area was 0.61 (0.50–0.75) among persons in the 0–44 age group. Among patients in the 45–64 age group, the corresponding IRR was 0.55 (0.47–0.65). The highest SES areas versus the lowest showed an IRR of 0.59 (0.50–0.70) in the 65–74 age group. In the two highest age groups, no significant association was seen (75–84 age group: 0.93 (0.80–1.08); 85+ age group: 1.05 (0.84–1.23)). Similar crude patterns were seen among both men and women.ConclusionsAreas characterised by high SES showed a significantly lower incidence of OHCA. This relationship was seen up to the age of 75, after which the relationship disappeared, suggesting a levelling effect.

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Socio-economic differences in incidence, bystander cardiopulmonary resuscitation and survival from out-of-hospital cardiac arrest: A systematic review

Cited by 68 publications

References 76 publications

Income is associated with the probability to receive early coronary angiography after out-of-hospital cardiac arrest

Income is associated with the probability to receive early coronary angiography after out-of-hospital cardiac arrest

Association Between Modifiable Prehospital Prognostic Factors on Out-Of-Hospital Cardiac Arrest in Different Age Groups

Relationship between socioeconomic status and incidence of out-of-hospital cardiac arrest is dependent on age

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