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Discriminatory cardiac arrest care? Patients with low socioeconomic status receive delayed cardiopulmonary resuscitation and are less likely to survive an in-hospital cardiac arrest.
Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University.
Department of Economics and Statistics, School of Business and Economics, Linnaeus University.
Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Cardiology, Sahlgrenska University Hospital.ORCID iD: 0000-0003-4139-6235
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2021 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 8, p. 861-869Article in journal (Refereed) Published
Abstract [en]

AIMS: Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors.

METHODS AND RESULTS: In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay.

CONCLUSION: There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.

Place, publisher, year, edition, pages
2021. Vol. 42, no 8, p. 861-869
Keywords [en]
Cardiopulmonary resuscitation, Discrimination, In-hospital cardiac arrest, Socioeconomic status, Survival
National Category
Cardiac and Cardiovascular Systems
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-24647DOI: 10.1093/eurheartj/ehaa954ISI: 000646253100013PubMedID: 33345270Scopus ID: 2-s2.0-85102219038OAI: oai:DiVA.org:hb-24647DiVA, id: diva2:1516535
Available from: 2021-01-12 Created: 2021-01-12 Last updated: 2021-07-07

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Herlitz, Johan

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