Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea.
Department of Emergency Medicine, Seoul National University, Boramae Medical Center, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea.
Resuscitation. 2018 May;126:130-136. doi: 10.1016/j.resuscitation.2018.02.025. Epub 2018 Mar 2.
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).
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.
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.
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.
本研究旨在比较不同社会经济地位（SES）社区之间院外心脏骤停（OHCA）后良好神经功能结局的时间趋势。
这是一项全国性的基于人群的观察性研究，纳入了 2006 年至 2015 年期间心脏病因所致 OHCA 的成年患者。社区 SES 采用 Carstairs 指数定义，分为 5 组，从 Q1（最不贫困）到 Q5（最贫困）。结局包括良好的神经功能结局、出院时存活和旁观者心肺复苏（CPR）的比例。使用多变量逻辑回归，我们根据社区 SES 检查了风险调整结局率的时间趋势，并估计了 2006 年至 2015 年之间的差异差异模型，以比较不同 SES 社区的随时间变化。
共纳入 120365 例 OHCA 符合纳入标准。旁观者 CPR（1.2%-23.2%）、出院存活率（3.0%-8.0%）和良好神经功能结局（0.9%-5.8%）的风险调整率从 2006 年到 2015 年有所增加。然而，SES 组中每个风险调整率的改善程度不同。SES 最高的社区显示出更大的改善（旁观者 CPR 1.6%-34.6%；出院存活率 3.5%-9.9%；和良好的神经功能结局 1.6%-7.4%），而 SES 较低的社区改善较小（1.6%-15.5%；2.3%-6.2%；和 0.5%-4.2%，分别）。对于旁观者 CPR 率，SES 最高社区的调整差异差异值具有统计学意义，显示从 SES 最低社区的增加 11.48%到 SES 最高社区的增加 22.39%的梯度。
在韩国，OHCA 后住院存活率和良好的神经功能结局在过去十年中有所改善。然而，根据社区社会经济地位，观察到结局存在差异。SES 较高的社区的改善最大，但 SES 较低的社区的改善相对较少。
