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Inequalities in income and education are associated with survival differences after out-of-hospital cardiac arrest : nationwide observational study
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0009-7322; 1524-4539
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Circulation, 2021, Vol. 144, No. 24, pp. 1915-1925
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JONSSON, Martin, HARKONEN, Juho, LJUNGMAN, Petter, NORDBERG, Per, RINGH, Mattias, HIRLEKAR, Geir, RAWSHANI, Araz, HERLITZ, Johan, LJUNG, Rickard, HOLLENBERG, Jacob, Inequalities in income and education are associated with survival differences after out-of-hospital cardiac arrest : nationwide observational study, Circulation, 2021, Vol. 144, No. 24, pp. 1915-1925 - https://hdl.handle.net/1814/75502
Abstract
Background:
Despite the acknowledged importance of socioeconomic factors as regards cardiovascular disease onset and survival, the relationship between individual-level socioeconomic factors and survival after out-of-hospital cardiac arrest is not established. Our aim was to investigate whether socioeconomic variables are associated with 30-day survival after out-of-hospital cardiac arrest.
Methods:
We linked data from the Swedish Registry for Cardiopulmonary Resuscitation with individual-level data on socioeconomic factors (ie, educational level and disposable income) from Statistics Sweden. Confounding and mediating variables included demographic factors, comorbidity, and Utstein resuscitation variables. Outcome was 30-day survival. Multiple modified Poisson regression was used for the main analyses.
Results:
A total of 31 373 out-of-hospital cardiac arrests occurring in 2010 to 2017 were included. Crude 30-day survival rates by income quintiles were as follows: Q1 (low), 414/6277 (6.6%); Q2, 339/6276 (5.4%); Q3, 423/6275 (6.7%); Q4, 652/6273 (10.4%); and Q5 (high), 928/6272 (14.8%). In adjusted analysis, the chance of survival by income level followed a gradient-like increase, with a risk ratio of 1.86 (95% CI, 1.65–2.09) in the highest-income quintile versus the lowest. This association remained after adjusting for comorbidity, resuscitation factors, and initial rhythm. A higher educational level was associated with improved 30-day survival, with the risk ratio associated with postsecondary education ≥4 years being 1.51 (95% CI, 1.30–1.74). Survival disparities by income and educational level were observed in both men and women.
Conclusions:
In this nationwide observational study using individual-level socioeconomic data, higher income and higher educational level were associated with better 30-day survival after out-of-hospital cardiac arrest in both sexes.
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Published online: 12 November 2021