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Heart. 2019 Apr;105(8):632-638. doi: 10.1136/heartjnl-2018-313838. Epub 2018 Oct 16.

Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status.

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Center for Resuscitation Science, Department for Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Political and Social Sciences, European University Institute, Florence, Italy.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Molecular and Clinical Medicine, Gothenburg University, Gothenburg, Sweden.
Center for Pre-Hospital Research, University of Borås, Borås, Sweden.



Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world. In this study we aimed to investigate the relationship between area-level socioeconomic status (SES) and 30-day survival after OHCA. We hypothesised that high SES at an area level is associated with an improved chance of 30-day survival.


Patients with OHCA in Stockholm County between 1 January 2006 and 31 December 2015 were analysed retrospectively. To quantify area-level SES, we linked the patient's home address to 250 × 250/1000 × 1000 meter grids with aggregated information about income and education. We constructed multivariable logistic regression models in which area-level SES measures were adjusted for age, sex, emergency medical services response time, witnessed status, initial rhythm, aetiology, location and year of cardiac arrest.


We included 7431 OHCAs. There was significantly greater 30-day survival (p=0.003) in areas with a high proportion of university-educated people. No statistically significant association was seen between median disposable income and 30-day survival. The adjusted OR for 30-day survival among patients in the highest educational quintile was 1.70 (95% CI 1.15 to 2.51) compared with patients in the lowest educational quintile. We found no significant interaction for sex. Positive trend with increasing area-level education was seen in both men and women but the trend was only statistically significant among men (p=0.012) CONCLUSIONS: Survival to 30 days after OHCA is positively associated with the average educational level of the residential area. Area-level income does not independently predict 30-day survival after OHCA.


cardiac arrest

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