Abstract 250: Pre-Hospital Factors and Survival After Out-of-Hospital Cardiac Arrest According to Patient Income and Education; a Danish Nationwide Study

Abstract

Introduction: Little is known about how patient socioeconomic status (income and education), relates to chance of bystander cardiopulmonary resuscitation (CPR) and survival after out-of-hospital cardiac arrest (OHCA). We assessed the association between patient socioeconomic status and bystander CPR as well as 30-day survival. Methods: OHCA patients ≥30 years of age and of presumed cardiac cause were identified through the nationwide Danish Cardiac Arrest Register, 2001-2014, and divided into high, medium and low subgroups according to 1) tertiles of household income from the year prior to OHCA and 2) highest degree of education according to the International Standard Classification of Education (ISCED) (<10 years, 10-12 years and >12 years of education). Associations of income and education with bystander CPR and 30-day survival were estimated using logistic multivariable logistic regression analysis adjusted for age, gender and calendar year. Results: In total, 25,233 OHCAs were included. Comparing patients in the highest group with patients in the lowest group of income and education, patients in the highest groups were younger, less often female and had less comorbidities. Patients in the highest groups were more likely to have: public arrests (income: 31.6% vs. 22.5%, education: 30.9% vs. 24.3%), witnessed arrests (income: 55.3% vs. 50.2%, education: 56.6% vs. 50.4%), bystander CPR (income: 52.4% vs. 34.7%, education: 51.6% vs. 40.9%) and an initial shockable heart rhythm (income: 37.6% vs. 22.1%, education: 35.7% vs. 24.1%), all p<0.001. High income and education compared to low were also associated with higher survival upon hospital arrival (income: 23.4% vs. 13.1%, education: 23.8% vs. 15.0%) and 30-day survival (income: 15.8% vs. 4.5%, education: 15.4% vs. 6.3%), p<0.001. Differences persisted in adjusted analyses: bystander CPR (high vs. low, income OR 1.43 95%CI 1.32-1.54, education OR 1.27 95%CI 1.17-1.39) and for 30-day survival (high vs. low, income OR 2.01 95%CI 1.74-2.31, education OR 2.08 95%CI 1.83-2.36). Conclusions: In this nationwide study of OHCA patients, higher socioeconomics status (income and education) was associated with higher rates of bystander CPR and 30-day survival, compared with those with lower socioeconomic status.