Chiang Wen-Chu, Ko Patrick Chow-In, Chang Anna Marie, Chen Wei-Ting, Liu Sot Shih-Hung, Huang Yu-Sheng, Chen Shey-Ying, Lin Chien-Hao, Cheng Ming-Tai, Chong Kah-Meng, Wang Hui-Chih, Yang Chih-Wei, Liao Mao-Wei, Wang Chen-Hsiung, Chien Yu-Chun, Lin Chi-Hung, Liu Yueh-Ping, Lee Bin-Chou, Chien Kuo-Long, Lai Mei-Shu, Ma Matthew Huei-Ming
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States.
Resuscitation. 2014 Jan;85(1):53-8. doi: 10.1016/j.resuscitation.2013.07.033. Epub 2013 Sep 19.
To determine the association of neighborhood socioeconomic status (SES) with bystander-initiated cardiopulmonary resuscitation (CPR) and patient outcomes of out of hospital cardiac arrests (OHCAs) in an Asian metropolitan area.
We performed a retrospective study in a prospectively collected cohort from the Utstein registry of adult non-traumatic OHCAs in Taipei, Taiwan. Average real estate value was assessed as the first proxy of SES. Twelve administrative districts in Taipei City were categorized into low versus high SES areas to test the association. The primary outcome was bystander-initiated CPR, and the secondary outcome was patient survival status. Factors associated with bystander-initiated CPR were adjusted for in multivariate analysis. The mean household income was assessed as the second proxy of SES to validate the association.
From January 1, 2008 to December 30, 2009, 3573 OHCAs received prehospital resuscitation in the community. Among these, 617 (17.3%) cases received bystander CPR. The proportion of bystander CPR in low-SES vs. high-SES areas was 14.5% vs. 19.6% (p<0.01). Odds ratio of receiving bystander-initiated CPR in low-SES areas was 0.72 (95% confidence interval: [0.60-0.88]) after adjusting for age, gender, witnessed status, public collapse, and OHCA unrecognized by the online dispatcher. Survival to discharge rate was significantly lower in low-SES areas vs. high-SES areas (4.3% vs. 6.8%; p<0.01). All results above remained consistent in the analyses by mean household income.
Patients who experienced an OHCA in low-SES areas were less likely to receive bystander-initiated CPR, and demonstrated worse survival outcomes.
确定亚洲大都市地区社区社会经济地位（SES）与旁观者实施的心肺复苏（CPR）以及院外心脏骤停（OHCA）患者预后之间的关联。
我们对台湾台北市成人非创伤性OHCA的前瞻性收集队列进行了回顾性研究，该队列来自Utstein登记处。平均房地产价值被评估为SES的首要指标。台北市的12个行政区被分为低SES地区和高SES地区，以检验这种关联。主要结局是旁观者实施的CPR，次要结局是患者生存状况。在多变量分析中对与旁观者实施CPR相关的因素进行了校正。平均家庭收入被评估为SES的第二个指标，以验证这种关联。
2008年1月1日至2009年12月30日，3573例OHCA在社区接受了院前复苏。其中，617例（17.3%）接受了旁观者CPR。低SES地区与高SES地区的旁观者CPR比例分别为14.5%和19.6%（p<0.01）。在校正年龄、性别、目击状态、公共场所倒地以及在线调度员未识别的OHCA后，低SES地区接受旁观者实施CPR的比值比为0.72（95%置信区间：[0.60 - 0.88]）。低SES地区的出院生存率显著低于高SES地区（4.3%对6.8%；p<0.01）。以上所有结果在按平均家庭收入进行的分析中保持一致。
在低SES地区发生OHCA的患者接受旁观者实施CPR的可能性较小，且生存结局较差。
