Chamberlain Rosemary C, Barnetson Calum, Clegg Gareth R, Halbesma Nynke
Usher Institute, University of Edinburgh, United Kingdom.
NHS Lothian, United Kingdom.
Resuscitation. 2020 Dec;157:49-59. doi: 10.1016/j.resuscitation.2020.09.025. Epub 2020 Oct 1.
Survival following out-of-hospital cardiac arrest (OHCA) is low, and poor survival appears associated with low socioeconomic position (SEP). We aimed to synthesise the evidence regarding association of specific SEP measures with OHCA survival, as well as effect modification and potential mediators, with the goal of informing efforts to improve survival by highlighting characteristics of populations requiring additional resources, and identifying modifiable factors.
MEDLINE and Embase databases were searched on 23 May 2019. Quantitative primary studies considering the association of any SEP measure with any OHCA survival measure were eligible. SEP could be measured at the level of the patient, their residential area, or OHCA location. Data on study characteristics and outcomes were extracted and a narrative review performed; this considered the evidence for overall SEP-survival association, variation in association of different SEP measures with survival, effect modification, and mediation.
Twenty-three studies were included. These were highly heterogeneous, particularly regarding SEP measures and eligibility criteria. Several studies report a SEP-survival association, with this being almost exclusively in the direction of lower survival with lower SEP. There is some indication that the education-survival association is particularly consistent but further work is needed to increase confidence here. No evidence of effect modification by age, sex or other factors was seen, although few studies considered this. No mediators were conclusively identified.
Low SEP is associated with poorer OHCA survival in at least some settings. It may be appropriate to consider populations' socioeconomic characteristics when targeting interventions to improve OHCA survival.
院外心脏骤停（OHCA）后的生存率较低，而较差的生存率似乎与社会经济地位（SEP）较低有关。我们旨在综合有关特定SEP指标与OHCA生存率之间关联的证据，以及效应修饰和潜在中介因素，以突出需要额外资源的人群特征并确定可改变的因素，从而为改善生存率的努力提供信息。
于2019年5月23日检索了MEDLINE和Embase数据库。纳入考虑任何SEP指标与任何OHCA生存指标之间关联的定量原发性研究。SEP可以在患者、其居住地区或OHCA发生地点的层面进行测量。提取有关研究特征和结果的数据并进行叙述性综述；这考虑了总体SEP与生存率关联、不同SEP指标与生存率关联的差异、效应修饰和中介作用的证据。
纳入了23项研究。这些研究具有高度异质性，尤其是在SEP指标和纳入标准方面。几项研究报告了SEP与生存率之间的关联，几乎无一例外都是SEP较低则生存率较低。有迹象表明教育程度与生存率之间的关联特别一致，但还需要进一步研究以增强对此的信心。尽管很少有研究考虑这一点，但未发现年龄、性别或其他因素产生效应修饰的证据。没有最终确定中介因素。
至少在某些情况下，SEP较低与OHCA生存率较差有关。在针对改善OHCA生存率的干预措施时，考虑人群的社会经济特征可能是合适的。
