Date: 2021
Type: Article
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
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
Retrieved from Cadmus, EUI Research Repository
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.
Additional information:
Published online: 12 November 2021
Cadmus permanent link: https://hdl.handle.net/1814/75502
Full-text via DOI: 10.1161/CIRCULATIONAHA.121.056012
ISSN: 0009-7322; 1524-4539
Publisher: Lippincott Williams & Wilkins
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