Socioeconomic status and survival from out-of-hospital cardiac arrest
Socioeconomic status and survival from out-of-hospital cardiac arrest
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DOI：
10.1197/j.aem.2005.05.031
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发表时间：
2005-10-01
影响因子：
4.4
通讯作者：
Rea, TD
中科院分区：
文献类型：
--
作者：
Clarke, SO;Schellenbaum, GD;Rea, TD
背景：社会经济地位（SES）与心脏病有关，但其对院外心脏骤停（OHCA）结果的影响尚不清楚。目的：作者假设较高的社会经济地位水平可能与更好的生存率有关，这可能与人口统计学、环境或护理因素有关。方法：对1999年1月1日至2003年12月31日在该县急诊就诊的心脏病OHCA患者进行队列调查。社会经济地位是用两种不同的方法来评估的：一种是个人层面的方法，即每单位的税收评估财产价值，另一种是基于地理的方法，即2000年人口普查的家庭收入中位数。作者采用logistic回归评价生存至出院与SES四分位数之间的关系。模型系统地调整了可能混淆关联的人口统计学、环境和护理因素。结果：在未调整的模型中，以每单位价值衡量的社会经济地位与生存率相关（优势比[OR] = 1.21； 95%置信区间[95% CI] = 1.05至1.36，每单位四分位数价值每连续增加一次）。人口统计学、环境和护理因素的调整仅轻微改变了相关性（完全调整后OR = 1.23; 95% CI = 1.08 ~ 1.39）。相比之下，以家庭收入中位数衡量的社会经济地位与生存无关。这项研究无法调查所有潜在的解释因素。调查结果可能无法推广到与当前调查不同的个人或社区。结论：独立于人口统计学、环境或护理因素，个体水平而非区域水平的SES测量预测OHCA后的生存。未来的研究应继续探讨SES与OHCA生存相关的机制。
Background: Socioeconomic status (SES) has been linked to heart disease, but its influence on outcome from out-of-hospital cardiac arrest (OHCA) is not well understood. Objectives: The authors hypothesized that higher levels of SES would be associated with better survival, potentially through demographic, circumstance, or care factors. Methods: A cohort investigation of OHCA due to heart disease treated by emergency medical services between January 1, 1999, and December 31, 2003, was conducted in the study county. Socioeconomic status was assessed using two different measures: an individual-level measure, tax-assessed property value per unit, and a geography-based measure, median household income from the 2000 Census. The authors used logistic regression to evaluate the association between survival to hospital discharge and quartile of SES. Models systematically adjusted for demographic, circumstance, and care factors that could potentially confound the association. Results: Socioeconomic status as measured by value per unit was associated with survival in unadjusted models (odds ratio [OR] = 1.21; 95% confidence interval [95% CI] = 1.05 to 1.36, for each successive increase in value-per-unit quartile). Adjustment for demographic, circumstance, and care factors altered the association only slightly (fully adjusted OR = 1.23; 95% CI = 1.08 to 1.39). In contrast, SES as measured by median household income was not associated with survival. The study could not investigate all potentially explanatory factors. The findings may not be generalizable to persons or communities that differ from the current investigation. Conclusions: An individual-level, but not an area-level, measure of SES predicted survival following OHCA independent of demographic, circumstance, or care factors. Future research should continue to investigate mechanisms through which SES is associated with OHCA survival.