Emergency Department, Toulouse University Hospital, 31000, Toulouse, France.
UMR 1027, Paul Sabatier University Toulouse III, Inserm, Toulouse, France.
BMC Public Health. 2021 Dec 2;21(1):2202. doi: 10.1186/s12889-021-12269-4.
In out-of-hospital cardiac arrest (OHCA), bystander initiated cardiopulmonary resuscitation (CPR) increases the chance of return of spontaneous circulation and survival with a favourable neurological status. Socioeconomic disparities have been highlighted in OHCA field. In areas with the lowest average socioeconomic status, OHCA incidence increased, and bystander CPR decreased. Evaluations were performed on restricted geographical area, and European evaluation is lacking. We aimed to analyse, at a national level, the impact of area-level social deprivation on the initiation of CPR in case of a witnessed OHCA.
We included all witnessed OHCA cases with age over 18 years from July 2011 to July 2018 form the OHCA French national registry. We excluded OHCA occurred in front of rescue teams or in nursing home, and patients with incomplete address or partial geocoding. We collected data from context, bystander and patient. The area-level social deprivation was estimated by the French version of the European Deprivation Index (in quintile) associated with the place where OHCA occurred. We assessed the associations between Utstein variables and social deprivation level using a mixed-effect logit model with bystander-initiated CPR.
We included 23,979 witnessed OHCA of which 12,299 (51%) had a bystander-initiated CPR. More than one third of the OHCA (8,326 (35%)) occurred in an area from the highest quintile of social deprivation. The higher the area-level deprivation, the less the proportion of bystander-initiated CPR (56% in Quintile 1 versus 48% in Quintile 5). The In the multivariable analysis, bystander less often began CPR in areas with the highest deprivation level, compared to those with the lowest deprivation level (OR=0.69, IC95%: 0.63-0.75).
The level of social deprivation of the area where OHCA occurred was associated with bystander-initiated CPR. It decreased in the more deprived areas although these areas also concentrate more younger patients.
在院外心脏骤停（OHCA）中，旁观者启动心肺复苏术（CPR）可增加自主循环恢复和生存并伴有有利神经状态的机会。OHCA 领域强调了社会经济差异。在社会经济地位最低的地区，OHCA 发病率增加，旁观者 CPR 减少。评估是在有限的地理区域进行的，而欧洲的评估则缺乏。我们旨在从全国范围分析地区社会剥夺水平对目击 OHCA 情况下 CPR 启动的影响。
我们纳入了 2011 年 7 月至 2018 年 7 月来自 OHCA 法国国家登记处的所有年龄大于 18 岁的目击 OHCA 病例。我们排除了在救援小组或养老院发生的 OHCA 病例，以及地址不完整或部分地理编码的患者。我们从背景、旁观者和患者方面收集数据。使用与 OHCA 发生地点相关的法国版欧洲剥夺指数（五分位数）估计地区社会剥夺水平。我们使用混合效应逻辑模型评估乌斯泰因变量与社会剥夺水平之间的关系，并使用旁观者启动的 CPR 进行调整。
我们纳入了 23979 例目击 OHCA，其中 12299 例（51%）有旁观者启动的 CPR。超过三分之一的 OHCA（8326 例（35%））发生在社会剥夺程度最高的五分位数区域。地区社会剥夺程度越高，旁观者启动 CPR 的比例越低（五分位数 1 中为 56%，五分位数 5 中为 48%）。在多变量分析中，与剥夺程度最低的地区相比，剥夺程度较高的地区旁观者更不愿意开始 CPR（OR=0.69，95%CI：0.63-0.75）。
OHCA 发生地点的社会剥夺程度与旁观者启动的 CPR 相关。在较贫困地区，CPR 的实施率下降，尽管这些地区也集中了更多的年轻患者。
