Allan Katherine S, Ray Joel G, Gozdyra Peter, Morrison Laurie J, Kiss Alexander, Buick Jason E, Zhan Cathy C, Dorian Paul
Division of Cardiology, St. Michael's Hospital, Toronto, Canada.
Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
Resuscitation. 2020 Apr;149:100-108. doi: 10.1016/j.resuscitation.2020.02.002. Epub 2020 Feb 14.
Numerous studies have shown significant neighbourhood level variation in out-of-hospital cardiac arrest (OHCA) incidence rates, however, few have provided an explanation for these disparities beyond traditional socioeconomic measures.
This was a retrospective study using data from a large population-based OHCA database (Rescu Epistry). We included adults ≥20 years who experienced a non-traumatic OHCA and were treated by emergency medical services within Toronto, Canada between 2006-2012. The residential address of each OHCA patient was spatially mapped to 1 of 517 Toronto census tracts (CTs). Patient and CT level characteristics were included in multivariate regression models to assess their association with OHCA incidence per 100,000 persons.
Of the 7775 OHCAs occurring in the study area, 7692 (98.9%) were eligible for inclusion. OHCA incidence rates varied widely across CT quintiles, with rates differing almost 4-fold (109.1 per 100,000 yearly Q5 most deprived vs. 30.0 per 100,000 yearly Q1 least deprived p < 0.0001). Numerous areas of high incidence adjacent to areas of low incidence were observed. After adjustment, all variables except the Activity Friendly Index showed highly significant linear trends, with increasing age, sex ratio, diabetes prevalence, material deprivation and ethnic concentration being independently associated with increasing OHCA incidence. In contrast, we did not observe a linear relationship between high OHCA incidence and median household income.
This study showed almost 4-fold OHCA incidence variability across a large metropolitan area. This variability was partially correlated with population and health data, but not typical socioeconomic predictors, such as median household income.
众多研究表明，院外心脏骤停（OHCA）发病率在社区层面存在显著差异，然而，除了传统的社会经济指标外，很少有研究能解释这些差异的原因。
这是一项回顾性研究，使用了来自一个大型的基于人群的OHCA数据库（Rescu Epistry）的数据。我们纳入了年龄≥20岁、经历非创伤性OHCA且在2006年至2012年期间在加拿大多伦多接受紧急医疗服务治疗的成年人。将每位OHCA患者的居住地址在空间上映射到多伦多517个普查区（CTs）中的1个。患者和CT层面的特征被纳入多变量回归模型，以评估它们与每10万人OHCA发病率的关联。
在研究区域发生的7775例OHCA中，7692例（98.9%）符合纳入条件。OHCA发病率在CT五分位数之间差异很大，发病率相差近4倍（最贫困的第5五分位数每年每10万人中有109.1例，最不贫困的第1五分位数每年每10万人中有30.0例，p<0.0001）。观察到许多高发病率区域与低发病率区域相邻。调整后，除活动友好指数外，所有变量均显示出高度显著的线性趋势，年龄增加、性别比、糖尿病患病率、物质匮乏和种族集中度增加均与OHCA发病率增加独立相关。相比之下，我们未观察到高OHCA发病率与家庭收入中位数之间存在线性关系。
本研究表明，在一个大都市地区，OHCA发病率的差异近4倍。这种差异部分与人口和健康数据相关，但与典型的社会经济预测指标（如家庭收入中位数）无关。
