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. 2024 Mar 20:18:100610.
doi: 10.1016/j.resplu.2024.100610. eCollection 2024 Jun.

Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study

Dawn Yi Xin Lee  1 , Chun En Yau  2 , Maeve Pin Pin Pek  3 , Hanzhang Xu  4 , Daniel Yan Zheng Lim  5   6 , Arul Earnest  7 , Marcus Eng Hock Ong  8 , Andrew Fu Wah Ho  8   9   10
Affiliations

Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study

Dawn Yi Xin Lee et al. Resusc Plus. .

Abstract

Background: Socioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore.

Methods: We conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan-Meier survival curves and calculated the predicted marginal probability for each SHI category.

Results: We included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88-1.10), 1.01 (0.93-1.11), 1.02 (0.93-1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75-1.38), 1.08 (0.84-1.38), 1.18 (0.91-1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories.

Conclusions: We did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.

Keywords: Cardiac arrest; Long-term survival; Mortality; Out-of-hospital cardiac arrest; Socioeconomic disadvantage; Socioeconomic status.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Overall survival of OHCA patients in Singapore by SHI.
Fig. 2
Fig. 2
Predicted marginal probability of survival by SHI.
See this image and copyright information in PMC

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