Wang Soonjoo, Park Hang A, Han Sangsoo, Park Ju Ok, Kim Sola, Lee Choung Ah
Department of Emergency Medicine, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea.
Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Republic of Korea.
Heliyon. 2024 Sep 19;10(20):e37904. doi: 10.1016/j.heliyon.2024.e37904. eCollection 2024 Oct 30.
The coronavirus disease 19 (COVID-19) pandemic has affected healthcare services, potentially leading to inequitable outcomes based on patients' socioeconomic status (SES). This study aimed to evaluate the impact of COVID-19 on out-of-hospital cardiac arrest (OHCA) outcomes by examining disparities across SES levels.
The study analyzed non-traumatic OHCA cases registered in the Korean Out-of-Hospital Cardiac Arrest Registry from 2010 to 2021, encompassing 238,668 patients aged 18 years and older. SES was assessed at both the individual (Medicaid vs non-Medicaid) and area levels using a deprivation index. Outcomes included any return of spontaneous circulation, survival to admission, survival to discharge, and favorable neurological recovery. Logistic regression and generalized additive models (GAMs) were used for analysis.
OHCA outcomes-including survival to admission, survival to discharge, and favorable neurological recovery-improved over the years, peaking in 2019 before subsequently declining. Logistic regression showed that the lowest SES area was associated with lower rates of ROSC (adjusted odds rations [aOR] 0.82, 95 % confidence interval [CI] 0.75-0.88) and survival to admission (aOR 0.56, 95%CI 0.49-0.64) and discharge (aOR 0.78, 95%CI 0.61-0.98) during the pandemic. GAM analysis revealed that lower SES groups (deprivation index levels 4 and 5) experienced higher-than-expected survival to admission and discharge rates, as well as favorable neurological recovery. Although outcomes in the deprivation index level 1 group (5.5 % in 2021) remained superior, indicating poor outcomes for the lowest SES area group (3.43 % in 2021), the disparity decreased following the pandemic.
Lower levels of SES are a significant risk factor for unfavorable neurological recovery in OHCA, independent of the COVID-19 pandemic. However, SES-related disparities in the outcomes decreased post-pandemic. Despite the overall negative impact of COVID-19, certain lower SES groups showed improved survival rates, likely due to differences in the EMS response and healthcare burden across regions.
2019冠状病毒病（COVID-19）大流行影响了医疗服务，可能导致基于患者社会经济地位（SES）的不公平结果。本研究旨在通过检查SES水平的差异来评估COVID-19对院外心脏骤停（OHCA）结果的影响。
该研究分析了2010年至2021年在韩国院外心脏骤停登记处登记的非创伤性OHCA病例，涵盖238,668名18岁及以上的患者。使用剥夺指数在个体（医疗补助与非医疗补助）和地区层面评估SES。结果包括自主循环恢复、入院存活、出院存活和良好的神经功能恢复。采用逻辑回归和广义相加模型（GAM）进行分析。
OHCA的结果，包括入院存活、出院存活和良好的神经功能恢复，多年来有所改善，在2019年达到峰值，随后下降。逻辑回归显示，在大流行期间，SES最低的地区与较低的自主循环恢复率（调整后的优势比[aOR]为0.82，95%置信区间[CI]为0.75-0.88）、入院存活率（aOR为0.56，95%CI为0.49-0.64）和出院存活率（aOR为0.78，95%CI为0.61-0.98）相关。GAM分析显示，SES较低的组（剥夺指数水平4和5）经历了高于预期的入院和出院存活率以及良好的神经功能恢复。尽管剥夺指数水平1组的结果（2021年为5.5%）仍然更好，表明SES最低的地区组的结果较差（2021年为3.43%），但大流行后这种差距有所缩小。
较低的SES水平是OHCA中神经功能恢复不良的一个重要危险因素，与COVID-19大流行无关。然而，可以看出大流行后SES相关的结果差异有所减少。尽管COVID-19有总体负面影响，但某些SES较低的组显示存活率有所提高，这可能是由于不同地区紧急医疗服务反应和医疗负担的差异。
