Abstract 262: Women Are Less Likely to Be Resuscitated than Men

Abstract

Background: There is a gender disparity in utilization of and benefit from health care. In various fields of medicine, women underuse the health care system and seem to benefit less when accessing health care than men. We aimed to study whether access to and outcome after out-of-hospital cardiopulmonary resuscitation (CPR) differs between men and women. Methods: We performed a population-based cohort study of non-traumatic out-of-hospital cardiac arrest (OHCA) cases before EMS arrival between 2006 and 2012. By using death certificate data of the national statistics service, we identified all cardiac out-of hospital deaths in the same period. Persons aged <20 years were excluded. First, we calculated the Mantel-Haenzel odds ratio (OR-MH) for gender and chance of a resuscitation attempt, while weighing the number of persons per age-category. Second, neurologically intact survival (NI-survival) after resuscitation attempt was regressed on gender in the total group and stratified according to score on resuscitation parameter. Third, multivariable logistic regression was used to assess the independent association between gender and shockable initial rhythm. Results: We identified 22,443 OHCAs (52.8% male), and recorded 6,038 CPR attempts after OHCA of cardiac cause (72.5% male). Men have a significantly higher chance of receiving a resuscitation attempt than women (pooled OR-MH 1.63, 95%CI 1.52-1.75, p<0.001). Women benefited less from CPR than men; NI-survival was higher in men compared to women (20.4% vs. 13.0%, OR 1.71, 95%CI 1.46-2.01, p<0.001). The gender gap in survival was explained by a lower incidence of a shockable initial rhythm in women (48.8% vs. 34.4%). Gender was independently associated with presence of a shockable initial rhythm (OR 1.83, 95%CI 1.60-2.09, p<0;001); so were CPR parameters. Conclusions: Women are less likely than men to receive CPR by EMS in case of OHCA. When women do receive CPR, they have lower chance of survival. The survival disparity is gender related and can only partly be explained by CPR circumstances.