Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest

Abstract

ObjectiveIt remains unknown whether patient socioeconomic factors affect interventions and survival after out-of-hospital cardiac arrest (OHCA), and whether a socioeconomic effect on bystander interventions affects survival. Therefore, this study examined patient socioeconomic disparities in prehospital factors and survival.MethodsFrom the Danish Cardiac Arrest Registry, patients with OHCA ≥30 years were identified, 2001–2014, and divided into quartiles of household income (highest, high, low, lowest). Associations between income and bystander cardiopulmonary resuscitation (CPR) and 30-day survival with bystander CPR as mediator were analysed by logistic regression and mediation analysis in private witnessed, public witnessed, private unwitnessed and public unwitnessed arrests, adjusted for confounders.ResultsWe included 21 480 patients. Highest income patients were younger, had higher education and were less comorbid relative to lowest income patients. They had higher odds for bystander CPR with the biggest difference in private unwitnessed arrests (OR 1.74, 95% CI 1.47 to 2.05). For 30-day survival, the biggest differences were in public witnessed arrests with 26.0% (95% CI 22.4% to 29.7%) higher survival in highest income compared with lowest income patients. Had bystander CPR been the same for lowest income as for highest income patients, then survival would be 25.3% (95% CI 21.5% to 29.0%) higher in highest income compared with lowest income patients, resulting in elimination of 0.79% (95% CI 0.08% to 1.50%) of the income disparity in survival. Similar trends but smaller were observed in low and high-income patients, the other three subgroups and with education instead of income. From 2002 to 2014, increases were observed in both CPR and survival in all income groups.ConclusionOverall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.

Inequalities in Income and Education Are Associated With Survival Differences After Out-of-Hospital Cardiac Arrest: Nationwide Observational Study

“…A recent Danish study, including OHCAs of cardiac origin, revealed similar results, with a clear association between income and the chance of 30-day survival. 13 …”

“… 9 Previous studies carried out with individual-level data are few and have suffered from small sample sizes as well as reliance on specific subgroups of the OHCA population, such as children and adolescents, 10 patients with shockable rhythm, 11 patients admitted to hospital, 12 and cardiac arrests of cardiac origin. 13 …”

“…9 Previous studies carried out with individuallevel data are few and have suffered from small sample sizes as well as reliance on specific subgroups of the OHCA population, such as children and adolescents, 10 patients with shockable rhythm, 11 patients admitted to hospital, 12 and cardiac arrests of cardiac origin. 13 Socioeconomic disparities in OHCA survival highlight the importance of appropriate policy measures that address the underlying causes of lower rates of survival in some groups-such as policies to reduce disparities in comorbidities and patterns of health behavior-as well as targeted interventions, such as training in cardiopulmo-nary resuscitation (CPR) and placement of automated external defibrillators (AEDs).…”

Successful resuscitation of sudden cardiac death: education matters

“…In fact, the latter only accounted for less than 1% of the difference in survival across the income groups. 3 Another, probably more likely, explanation for the observed difference in survival, mentioned by Møller et al, is the quality of the intervention as performed by the bystander. Similar findings were obtained when categorising patients based on their level of education.…”

“…Similar findings were obtained when categorising patients based on their level of education. 3 The study conducted by Møller et al shows that survival following SCD depends on one's socioeconomic status, among other factors. Reducing the socioeconomic disparity in survival seen in these patients should be high on the agenda of all stakeholders.…”