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

Sidsel Møller; Mads Wissenberg; Liis Starkopf; Kristian Kragholm; Steen M Hansen; Kristian Bundgaard Ringgren; Fredrik Folke; Julie Andersen; Carolina Malta Hansen; Freddy Lippert; Lars Koeber; Gunnar Hilmar Gislason; Christian Torp-Pedersen; Thomas A Gerds

doi:10.1136/heartjnl-2020-317761

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

Sidsel Møller, Mads Wissenberg, Liis Starkopf, Kristian Kragholm, Steen M Hansen, Kristian Bundgaard Ringgren, Fredrik Folke, Julie Andersen, Carolina Malta Hansen, Freddy Lippert, Lars Koeber, Gunnar Hilmar Gislason, Christian Torp-Pedersen, Thomas A Gerds

23 Citationer (Scopus)

Abstract

OBJECTIVE: It 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.

METHODS: From 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.

RESULTS: We 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.

CONCLUSION: Overall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.

Originalsprog	Engelsk
Tidsskrift	Heart (British Cardiac Society)
Vol/bind	107
Udgave nummer	8
Sider (fra-til)	627-634
Antal sider	8
ISSN	1355-6037
DOI	https://doi.org/10.1136/heartjnl-2020-317761
Status	Udgivet - apr. 2021

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10.1136/heartjnl-2020-317761

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Møller, S., Wissenberg, M., Starkopf, L., Kragholm, K., Hansen, S. M., Ringgren, K. B., Folke, F., Andersen, J., Malta Hansen, C., Lippert, F., Koeber, L., Gislason, G. H., Torp-Pedersen, C., & Gerds, T. A. (2021). Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest. Heart (British Cardiac Society), 107(8), 627-634. https://doi.org/10.1136/heartjnl-2020-317761

Møller, S, Wissenberg, M, Starkopf, L, Kragholm, K, Hansen, SM, Ringgren, KB, Folke, F, Andersen, J, Malta Hansen, C, Lippert, F, Koeber, L , Gislason, GH , Torp-Pedersen, C & Gerds, TA 2021, 'Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest', Heart (British Cardiac Society), bind 107, nr. 8, s. 627-634. https://doi.org/10.1136/heartjnl-2020-317761

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title = "Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest",

abstract = "OBJECTIVE: It 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.METHODS: From 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.RESULTS: We 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.CONCLUSION: Overall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.",

keywords = "cardiac arrest, epidemiology, health services, quality and outcomes of care",

author = "Sidsel M{\o}ller and Mads Wissenberg and Liis Starkopf and Kristian Kragholm and Hansen, {Steen M} and Ringgren, {Kristian Bundgaard} and Fredrik Folke and Julie Andersen and {Malta Hansen}, Carolina and Freddy Lippert and Lars Koeber and Gislason, {Gunnar Hilmar} and Christian Torp-Pedersen and Gerds, {Thomas A}",

year = "2021",

month = apr,

doi = "10.1136/heartjnl-2020-317761",

language = "English",

volume = "107",

pages = "627--634",

journal = "Heart (British Cardiac Society)",

issn = "1355-6037",

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T1 - Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest

AU - Møller, Sidsel

AU - Wissenberg, Mads

AU - Starkopf, Liis

AU - Kragholm, Kristian

AU - Hansen, Steen M

AU - Ringgren, Kristian Bundgaard

AU - Folke, Fredrik

AU - Andersen, Julie

AU - Malta Hansen, Carolina

AU - Lippert, Freddy

AU - Koeber, Lars

AU - Gislason, Gunnar Hilmar

AU - Torp-Pedersen, Christian

AU - Gerds, Thomas A

PY - 2021/4

Y1 - 2021/4

N2 - OBJECTIVE: It 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.METHODS: From 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.RESULTS: We 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.CONCLUSION: Overall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.

AB - OBJECTIVE: It 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.METHODS: From 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.RESULTS: We 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.CONCLUSION: Overall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.

KW - cardiac arrest

KW - epidemiology

KW - health services

KW - quality and outcomes of care

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U2 - 10.1136/heartjnl-2020-317761

DO - 10.1136/heartjnl-2020-317761

M3 - Journal article

C2 - 33419881

SN - 1355-6037

VL - 107

SP - 627

EP - 634

JO - Heart (British Cardiac Society)

JF - Heart (British Cardiac Society)

IS - 8

ER -

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

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