Abstract
Background
The objective of this study was to compare the temporal trends in good neurologic
outcome after out-of-hospital cardiac arrest (OHCA) between communities with different
socioeconomic status (SES).
Methods
A nationwide, population-based observational study was conducted in adult patients
with OHCA of cardiac etiology from 2006 to 2015. Community SES was defined using the
Carstairs index categorized into 5 groups, from Q1 (the least deprived) to Q5 (the
most deprived). Outcomes included good neurologic outcome, survival to hospital discharge
and rate of bystander cardiopulmonary resuscitation (CPR). Using multivariable logistic
regression, we examined temporal trends in risk-adjusted outcome rates according to
community SES and estimated a difference-in-differences model between 2006 and 2015
to compare the changes over time in communities with different SES.
Results
A total of 120,365 OHCAs met inclusion criteria. Risk-adjusted rates increased from
2006 to 2015 for bystander CPR (1.2%–23.2%), survival to discharge (3.0%–8.0%), and
good neurological outcome (0.9%–5.8%). However, the degree of improvement in each
risk-adjusted rate among SES groups were different. The communities with highest SES
showed much greater improvement (bystander CPR 1.6%–34.6%; survival to discharge 3.5%–9.9%;
and good neurological outcome 1.6%–7.4%) while less improvement in lower SES communities
(1.6%–15.5%; 2.3%–6.2%; and 0.5%–4.2%, respectively). For rates of bystander CPR,
the adjusted difference-in-differences value was statistically significant in highest
SES communities, showing gradient from 11.48% increase in the lowest SES to 22.39%
increase in the highest SES.
Conclusion
In Korea, both survival to hospital discharge and good neurologic outcomes after OHCA
have improved during the past decade. However, disparity in outcomes was observed
based on community socioeconomic status. Outcome improvements were greatest in communities
with higher SES but relatively less in lower SES communities.
Keywords
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Article info
Publication history
Published online: February 23, 2018
Accepted:
February 20,
2018
Received in revised form:
February 6,
2018
Received:
November 9,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.02.025.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
