Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: A population-based cohort study in the Netherlands

Bolijn, Renee; Sieben, Cenne H.A.M.; Kunst, Anton E.; Blom, Marieke T.; Tan, Hanno L.; Valkengoed, Irene G. M. van

doi:10.1016/j.ijcard.2021.09.007

Cited by 10 publications

(10 citation statements)

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“… 1 , 2 For example, the age‐standardized incidence of OHCA in the Netherlands between 2009 and 2015 was 87.3 per 100,000 person‐years for males versus 30.9 per 100,000 person‐years for females. 3 This difference is most likely due to males having a higher risk of cardiovascular disease (CVD) than females. 4 However, in contrast to the well‐known sex differences in incidence of OHCA, the existing evidence on sex differences in survival after OHCA is inconclusive.…”

Section: Introductionmentioning

confidence: 99%

“…It is well‐known that males are more likely to experience out‐of‐hospital cardiac arrest (OHCA) than females 1,2 . For example, the age‐standardized incidence of OHCA in the Netherlands between 2009 and 2015 was 87.3 per 100,000 person‐years for males versus 30.9 per 100,000 person‐years for females 3 . This difference is most likely due to males having a higher risk of cardiovascular disease (CVD) than females 4 .…”

Section: Introductionmentioning

confidence: 99%

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Association between sex and survival after out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis

et al. 2023

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The current literature on sex differences in 30‐day survival following out‐of‐hospital cardiac arrest (OHCA) is conflicting, with 3 recent systematic reviews reporting opposing results. To address these contradictions, this systematic literature review and meta‐analysis aimed to synthesize the literature on sex differences in survival after OHCA by including only population‐based studies and through separate meta‐analyses of crude and adjusted effect estimates. MEDLINE and Embase databases were systematically searched from inception to March 23, 2022 to identify observational studies reporting sex‐specific 30‐day survival or survival until hospital discharge after OHCA. Two meta‐analyses were conducted. The first included unadjusted effect estimates of the association between sex and survival (comparing males vs females), whereas the second included effect estimates adjusted for possible mediating and/or confounding variables. The PROSPERO registration number was CRD42021237887, and the search identified 6712 articles. After the screening, 164 potentially relevant articles were identified, of which 26 were included. The pooled estimate for crude effect estimates (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.22–1.66) indicated that males have a higher chance of survival after OHCA than females. However, the pooled estimate for adjusted effect estimates shows no difference in survival after OHCA between males and females (OR, 0.93; 95% CI, 0.84–1.03). Both meta‐analyses involved high statistical heterogeneity between studies: crude pooled estimate I 2 = 95.7%, adjusted pooled estimate I 2 = 91.3%. There does not appear to be a difference in survival between males and females when effect estimates are adjusted for possible confounding and/or mediating variables in non‐selected populations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between sex and survival after out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis

et al. 2023

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“…Moreover, some underrepresented racial and ethnic groups may have lower chances than the majority group to survive OHCA, 28 and this may be different for women and men. Although it has been observed that sex differences in OHCA incidence were consistent among ethnic groups, 25 future work should explore whether this is also the case of OHCA survival trends. Last, the generalizability of our findings may be limited.…”

Section: Discussionmentioning

confidence: 94%

“…We only included OHCA cases registered in ARREST, which are all EMS‐attended, while women are less likely to experience OHCA attended by EMS. 25 However, this is unlikely to have affected our comparison of temporal trends, as there are no indications that the ratio of sudden cardiac death to EMS‐attended OHCA has changed over time. 26 Further, survival is likely to be lower in recurrent OHCA events, 27 and the inclusion of recurrent cases in our study may have had an impact on the observed survival rates.…”

Section: Discussionmentioning

confidence: 97%

Sex Differences in Out‐of‐Hospital Cardiac Arrest Survival Trends

Smits,

Tan,

van Valkengoed

2024

JAHA

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Background Out‐of‐hospital cardiac arrest survival rates have improved over time. This study established whether improvements were similar for women and men, and to what extent resuscitation characteristics or in‐hospital procedures contributed to sex differences in temporal trends. Methods and Results This retrospective cohort study included 3386 women and 8564 men from North Holland, the Netherlands, who experienced an out‐of‐hospital cardiac arrest from a cardiac cause in 2005 to 2017. Yearly rates of 30‐day survival and secondary outcomes were calculated. Sex differences in temporal trends were evaluated with age‐adjusted Poisson regression analysis, including interaction for sex and out‐of‐hospital cardiac arrest year. Resuscitation characteristics and in‐hospital procedures were added to the model, and a spline at 2013 was considered. During the study period, the average 30‐day survival was 24.9% in men and 15.7% in women. The 30‐day survival rate increased in men (20% to 27.2%; P <0.001) but not in women (15.0% to 11.6%; P =0.40). The increase in the 30‐day survival rate was 3% higher per year in men than in women (rate ratio, 1.03 [95% CI, 1.00–1.05]), with a stronger difference after 2013. Men had a larger increase in survival rate to the hospital arrival than women in 2005 to 2013, and, after 2013, an advantage over women in survival rate after hospital arrival. The sex differences were partly explained by differing trends in shockable initial rhythm (eg, adjusted rate ratio, 1.01 [95% CI, 0.99–1.03] for 30‐day survival) and provision of in‐hospital procedures. Conclusions Changes in rates of 30‐day survival, survival to hospital arrival, and, after 2013, survival from hospital arrival to 30 days were more beneficial in men than women. The differences in trends were partly explained by shockable initial rhythm and in‐hospital procedures.

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“…30 Additionally, our findings indicate a higher incidence in males than females, aligning with consistent patterns observed in previous studies. 31 , 32 …”

Section: Discussionmentioning

confidence: 99%

Epidemiology and outcome of out‐of‐hospital cardiac arrest in Salt Lake City: Sex‐based investigations

Awad,

Hopkins,

Palatinus

et al. 2024

JACEP Open

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ObjectivesPrior research indicates sex disparities in the incidence and outcomes of out‐of‐hospital cardiac arrest (OHCA). This study investigates the presence of such differences in Salt Lake City, Utah.MethodsWe analyzed data from the Salt Lake City Fire Department (2008‒2023). We included adults with non‐traumatic OHCA. We calculated the annual incidence of OHCA and examined sex‐specific survival outcomes using multivariable logistic regression, adjusting for OHCA characteristics known to be associated with survival.ResultsThe annual incidence of OHCA was 76 per 100,000 person‐years. Among the 894 OHCA cases included in the analysis, 67.5% were males, 37.3% achieved return of spontaneous circulation (ROSC), and 13.6% survived hospital discharge. Unadjusted analysis revealed that males had significantly higher OHCA in public locations (43.9% vs. 28.6%), witnessed arrests (54.5% vs. 47.8%), and shockable rhythms (33.3% vs. 22.9%). Males also showed higher rates of ROSC (37.5% vs. 36.9%), hospital discharge survival (14.5% vs. 11.7%), and neurologically intact survival. After adjusting for the OHCA characteristics, there was no significant differences between males and females in ROSC, survival to hospital discharge, and favorable neurological function with adjusted odds ratios (male vs. female) of 0.92 (95% confidence interval [CI] 0.73‒1.16), 0.85 (95% CI 0.59‒1.22), and 0.92 (95% CI 0.62‒1.40), respectively.ConclusionApproximately, 128 adults suffer OHCA in Salt Lake City annually. Males initially showed higher crude survival rates, but after adjusting for OHCA characteristics, no significant sex differences in survival outcomes were found. Enhancing OHCA characteristics could benefit both sexes. Investigations into the relationship between sex‐ and region‐specific factors influencing OHCA outcomes are needed.

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Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: A population-based cohort study in the Netherlands

Cited by 10 publications

References 35 publications

Association between sex and survival after out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis

Association between sex and survival after out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis

Sex Differences in Out‐of‐Hospital Cardiac Arrest Survival Trends

Epidemiology and outcome of out‐of‐hospital cardiac arrest in Salt Lake City: Sex‐based investigations

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