Relationship between socioeconomic factors, distribution of public access defibrillators and incidence of out-of-hospital cardiac arrest

Abstract

Background: Survival from out-of-hospital cardiac arrest (OHCA) is improved when public access defibrillators are used. Areas of socioeconomic deprivation may have higher rates of OHCA and thus a greater demand for public access defibrillators. We aimed to determine if there was a relationship between socioeconomic factors, the geographic distribution of public access defibrillators (PADs) and incidence of OHCA. . Relationships between these variables were analysed using a Poisson regression analysis.Results: Cardiac arrest incidence increased with increasing deprivation. The incidence in the most deprived areas of 156.5 events per 100,000 person years (135.4-180.9, 95% CI) is double the incidence in the least deprived areas at 78.0 events per 100,000 person years (66.4-91.7, 95% CI). Significant increases in the rates of OHCA were observed with every 1% increase in proportions of Maori (1.0%, 0.61-1.4%, 95% CI, p = 0.001), Pacific Peoples (0.6%, 0.21-0.9%, p = 0.005), >65 year olds (3.7%, 3.0-4.3%, p < 0.001), and males (3.7%, 1.8-5.6%, p < 0.001). In 2018, the decile 10 areas had the lowest coverage of PADs (65% of these areas contained a PAD) compared with less deprived areas (68-84%, median 81%). Resuscitation j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r e s u s c i t a t i o nConclusions: The most socioeconomically deprived communities had the highest incidence of OHCA and the least availability of PADs. This provides impetus for targeted PAD placement in areas of higher deprivation.

Direct transport to PCI-capable hospitals after out-of-hospital cardiac arrest in New Zealand: Inequities and outcomes

“…19 Health inequities are well documented for Maori; rurality is one contributing dimension of this. 20 For both age and ethnicity, it is likely that the geographic location of the OHCA directly impacts on transport to a PCI-capable hospital. However, this study did not specifically investigate whether there was any bias on the part of attending ambulance crews or whether features of the cardiac arrest (shockable vs non-shockable rhythm, bystander CPR) could have influenced transport destination decisions.…”

Are there disparities in the location of automated external defibrillators in England?

“…In New Zealand the most socioeconomically deprived communities had the highest incidence of OHCA and the least availability of AEDs. 37 In the USA Zip codes that had high-access to AEDs also tended to have a higher median household income with a slightly higher proportion of the population being high school graduates, 16 and also a lower median residential population and a higher proportion of unemployed residents. In Seoul, more affluent neighbourhoods exhibit higher per capita AEDs, even when accounting for OHCA risk, with 4.92 AEDs per 10,000 in the lowest socio-economic status quartile and 12.66 per 10,000 in highest.…”

Factors affecting public access defibrillator placement decisions in the United Kingdom: A survey study

“…Respondents also currently use risk assessment methods to estimate the need for PADs in a given location to facilitate the best use of limited resources and benefit to communities. Some report taking a targeted approach placing PADs in deprived areas, which generally also have the highest rates of OHCA, 28 , 29 , 30 have lower rates of PAD deployment, 29 , 31 and have poorer OHCA survival outcomes. 3 , 32 , 33 , 34 A recent study in Scotland found poor alignment between PAD and OHCA locations across levels of socioeconomic deprivation as measured by the Scottish Index of Multiple Deprivation (SIMD): in particular, OHCAs in SIMD quintile 1 (including the most deprived communities) were least likely to have PADs.…”