Objective It remains unknown whether patient socioeconomic factors affect interventions and survival after out-of-hospital cardiac arrest (OHCA), and whether a socioeconomic effect on bystander interventions affects survival. Therefore, this study examined patient socioeconomic disparities in prehospital factors and survival.
Methods From the Danish Cardiac Arrest Registry, patients with OHCA ≥30 years were identified, 2001–2014, and divided into quartiles of household income (highest, high, low, lowest). Associations between income and bystander cardiopulmonary resuscitation (CPR) and 30-day survival with bystander CPR as mediator were analysed by logistic regression and mediation analysis in private witnessed, public witnessed, private unwitnessed and public unwitnessed arrests, adjusted for confounders.
Results We included 21 480 patients. Highest income patients were younger, had higher education and were less comorbid relative to lowest income patients. They had higher odds for bystander CPR with the biggest difference in private unwitnessed arrests (OR 1.74, 95% CI 1.47 to 2.05). For 30-day survival, the biggest differences were in public witnessed arrests with 26.0% (95% CI 22.4% to 29.7%) higher survival in highest income compared with lowest income patients. Had bystander CPR been the same for lowest income as for highest income patients, then survival would be 25.3% (95% CI 21.5% to 29.0%) higher in highest income compared with lowest income patients, resulting in elimination of 0.79% (95% CI 0.08% to 1.50%) of the income disparity in survival. Similar trends but smaller were observed in low and high-income patients, the other three subgroups and with education instead of income. From 2002 to 2014, increases were observed in both CPR and survival in all income groups.
Conclusion Overall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.
- cardiac arrest
- quality and outcomes of care
- health services
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Contributors SM contributed to the conception and design of the study, the data acquisition, the data analysis, the data interpretation, the manuscript drafting and the critical revision of the manuscript. SM has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. MW, LS, CTP and TAG contributed to the conception and design of the study, the supervision, the data acquisition, the data analysis, the data interpretation, the manuscript drafting and the critical revision of the manuscript. KK contributed to the conception and design of the study, the data interpretation, the manuscript drafting and the critical revision of the manuscript. SMH, KBR, FF, JA, CMH, FL, LK and GHG contributed to the data interpretation, the manuscript drafting and the critical revision of the manuscript.
Funding SM has received grants from Karen Elise Jensens Fond, Laerdal Foundation and Helsefonden. FF has received grants from Novo Nordisk Foundation and Laerdal Foundation. CMH has received grants from TrygFonden, Helsefonden and Laerdal Foundation. KK has received grants from Laerdal Foundation. GHG has received grants from Novo Nordisk. CTP has received grants from Bayer and Novo Nordisk.
Disclaimer The Danish Cardiac Arrest Registry is supported by TrygFonden but has no commercial interests in the OHCA area, and has no influence in the management, design, data collection, analyses, interpretation of data, preparation, review, reporting, manuscript approval or submission decision for publication of this study.
Competing interests LK has received lecture fees from Sanofi and Novartis.
Patient consent for publication Not required.
Ethics approval The Danish Data Protection Agency (reference number 2007-58-0015, local reference number GEH-2014-017, I-Suite number 02735) has approved this study. In Denmark, registry-based studies do not require ethical approval.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The data in the manuscript are completely deidentifiable data.
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