Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark.
Department of Clinical Medicine University of Copenhagen Copenhagen Denmark.
J Am Heart Assoc. 2023 May 16;12(10):e8322. doi: 10.1161/JAHA.122.028449. Epub 2023 May 9.
Background Survival from out-of-hospital cardiac arrest (OHCA) varies across regions. The aim of this study was to evaluate the association between urbanization (rural, suburban, and urban areas), bystander interventions (cardiopulmonary resuscitation and defibrillation), and 30-day survival from OHCAs in Denmark. Methods and Results We included OHCAs not witnessed by ambulance staff in Denmark from January 1, 2016, to December 31, 2020. Patients were divided according to the Eurostat Degree of Urbanization Tool in rural, suburban, and urban areas based on the 98 Danish municipalities. Poisson regression was used to estimate incidence rate ratios. Logistic regression (adjusted for ambulance response time) tested differences between the groups with respect to bystander interventions and survival, according to degree of urbanization. A total of 21 385 OHCAs were included, of which 8496 (40%) occurred in rural areas, 7025 (33%) occurred in suburban areas, and 5864 (27%) occurred in urban areas. Baseline characteristics, as age, sex, location of OHCA, and comorbidities, were comparable between groups. The annual incidence rate ratio of OHCA was higher in rural areas (1.54 [95% CI, 1.48-1.58]) compared with urban areas. Odds for bystander cardiopulmonary resuscitation were lower in suburban (0.86 [95% CI, 0.82-0.96]) and urban areas (0.87 [95% CI, 0.80-0.95]) compared with rural areas, whereas bystander defibrillation was higher in urban areas compared with rural areas (1.15 [95% CI, 1.01-1.31]). Finally, 30-day survival was higher in suburban (1.13 [95% CI, 1.02-1.25]) and urban areas (1.17 [95% CI, 1.05-1.30]) compared with rural areas. Conclusions Degree of urbanization was associated with lower rates of bystander defibrillation and 30-day survival in rural areas compared with urban areas.
院外心脏骤停（OHCA）的存活率因地区而异。本研究旨在评估丹麦城市化水平（农村、郊区和城市地区）、旁观者干预（心肺复苏和除颤）与 OHCA 30 天存活率之间的关系。
我们纳入了 2016 年 1 月 1 日至 2020 年 12 月 31 日期间丹麦非救护车工作人员目击的 OHCA。根据丹麦 98 个市的 Eurostat 城市化程度工具，患者分为农村、郊区和城市地区。使用泊松回归估计发病率比。逻辑回归（根据救护车响应时间调整）根据城市化程度测试了旁观者干预和存活率之间的差异。共纳入 21385 例 OHCA，其中 8496 例（40%）发生在农村地区，7025 例（33%）发生在郊区，5864 例（27%）发生在城市地区。各组之间的基线特征（年龄、性别、OHCA 发生地点和合并症）相似。农村地区 OHCA 的年发病率比（1.54[95%CI，1.48-1.58]）高于城市地区。与农村地区相比，郊区（0.86[95%CI，0.82-0.96]）和城市地区（0.87[95%CI，0.80-0.95]）旁观者心肺复苏的几率较低，而城市地区旁观者除颤的几率较高与农村地区相比（1.15[95%CI，1.01-1.31]）。最后，郊区（1.13[95%CI，1.02-1.25]）和城市地区（1.17[95%CI，1.05-1.30]）的 30 天生存率高于农村地区。
与城市地区相比，农村地区的城市化程度与旁观者除颤率和 30 天生存率较低有关。
