Ethnic disparities in the incidence and outcome from out-of-hospital cardiac arrest: A New Zealand observational study

Purpose of review Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which a rapid response following the chain of survival is crucial to save life. Disparities in care can occur at each link in this pathway and hence produce health inequities. This review summarises the health inequities that exist for OHCA patients and suggests how they may be addressed. Recent findings There is international evidence that the incidence of OHCA is increased with increasing deprivation and in ethnic minorities. These groups have lower rates of bystander CPR and bystander-initiated defibrillation, which may be due to barriers in accessing cardiopulmonary resuscitation training, provision of public access defibrillators, and language barriers with emergency call handlers. There are also disparities in the ambulance response and in-hospital care following resuscitation. These disadvantaged communities have poorer survival following OHCA. Summary OHCA disproportionately affects deprived communities and ethnic minorities. These groups experience disparities in care throughout the chain of survival and this appears to translate into poorer outcomes. Addressing these inequities will require coordinated action that engages with disadvantaged communities.

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“…1) [7]. A greater incidence of OHCA within ethnic minorities has been found in other countries too [8][9][10][11].…”

Section: Out-of-hospital Cardiac Arrest Incidence and Risk Factorsmentioning

confidence: 94%

Health inequities in out-of-hospital cardiac arrest

Boulton

Rios

Perkins

2022

Current Opinion in Critical Care

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“…We used standardised disposable household income 23 (henceforth, household income) data divided into quintiles based on the total population, provided by Dutch tax authorities to Statistics Netherlands, as a proxy for socioeconomic position of the household. Ethnicity 24 was determined based on the country of birth of the participants and their parents, according to the definition used by Statistics Netherlands. 25 We included hypertension, diabetes mellitus and dyslipidaemia dichotomised into yes/no as metabolic risk factors, using data on medication use from dispensing records of all public pharmacies in the Netherlands, for the year preceding the reference date.…”

Section: Other Variablesmentioning

confidence: 99%

Gender-related factors and out-of-hospital cardiac arrest incidence in women and men: analysis of a population-based cohort study in the Netherlands

Smits

Dongen

Blom

et al. 2022

J Epidemiol Community Health

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BackgroundThe incidence of out-of-hospital cardiac arrest (OHCA) differs consistently between women and men. Besides sex-related (biological) factors, OHCA risk may relate to gender-related (sociocultural) factors. We explored the association of selected gender-related factors with OHCA incidence in women and men.MethodsWe combined data on emergency medical services-attended OHCA with individual-level data from all women and men aged ≥25 years living in North Holland, the Netherlands. We estimated the associations between employment status, primary earner status, living with children and marital status and the OHCA incidence with Cox proportional hazards models stratified by sex and adjusted for age and socioeconomic status. To determine if metabolic factors explain the associations, we added hypertension, diabetes mellitus and dyslipidaemia to the models. Population attributable fractions (PAF) for all gender-related factors were calculated.ResultsAll four gender-related factors were associated with OHCA incidence (eg, unemployed vs employed; HR 1.98, 95% CI 1.67 to 2.35 in women; HR 1.60, 95% CI 1.44 to 1.79 in men). In both sexes, those unemployed, those who are not primary earners, those living without children, and married or divorced individuals had an increased OHCA risk. The PAF ranged from 4.9 to 40.3 in women and from 4.4 to 15.5 in men, with the highest PAF for employment status in both sexes. Metabolic risk factors did not explain the observed associations.ConclusionGender-related factors were associated with risk of OHCA and contributed substantially to the OHCA burden at the population level, particularly in women. Employment status contributed most to the OHCA burden.

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“…Previous studies from the United States of America (USA) [13,14], Singapore [15], and New-Zealand [16] reported substantial ethnic differences in EMS-attended OHCA incidence rates, but these studies did not report on sex differences across ethnic groups. A study from the USA observed that ethnic differences in sudden cardiac death (SCD), which also includes OHCA-related deaths, were more pronounced in women compared to men [17], suggesting that sex differences in OHCA incidence may vary across ethnic groups.…”

Section: Introductionmentioning

confidence: 97%