Socioeconomic status and incidence of sudden cardiac arrest
Socioeconomic status and incidence of sudden cardiac arrest
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DOI：
10.1503/cmaj.101512
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发表时间：
2011-10-18
影响因子：
14.6
通讯作者：
Chugh, Sumeet S.
中科院分区：
文献类型：
--
作者：
Reinier, Kyndaron;Thomas, Elizabeth;Chugh, Sumeet S.
背景：低社会经济地位与心血管健康状况不佳相关。我们评估了社会经济地位与心脏骤停发生率之间的关系，心脏骤停在北美七个大城市人群中占心血管相关死亡的很大比例。方法：使用基于人群的登记，我们收集了2006年4月1日至2007年3月31日期间在家中或居住机构发生的院外心脏骤停的数据。我们将分析限制在美国（德克萨斯州的达拉斯、宾夕法尼亚州的匹兹堡、俄勒冈州的波特兰和华盛顿州的西雅图-金县）和加拿大（安大略省的渥太华和多伦多以及不列颠哥伦比亚省的温哥华）的七个大都市地区的心脏骤停。每个事件都与一个人口普查区有关；各区按家庭收入中位数分成四分位数。结果：9235例心脏骤停纳入分析。综合所有站点，最低社会经济四分位数的心脏骤停发生率几乎是最高社会经济四分位数的两倍（发病率比[IRR] 1.9, 95%可信区间[CI] 1.8-2.0）。65岁以下人群（IRR 2.7, 95% CI 2.5-3.0）比65岁以上人群（IRR 1.3, 95% CI 1.2-1.4）差异更大。在对研究地点和每个人口普查区的人口年龄结构进行调整后，美国所有年龄段的社会经济四分位数的差异（IRR 2.0, 95% CI 1.9-2.2）大于加拿大（IRR 1.8, 95% CI 1.6-2.0）（相互作用p < 0.001）。解释：在美国和加拿大的贫困社区中，家中或居住机构的心脏骤停发生率较高，尽管在加拿大这种关联有所减弱。在65岁以下的人群中，社会经济四分位数之间的差距最大。社会经济地位与心脏骤停发生率之间的关系值得考虑，以制定提高心脏骤停存活率的策略，并可能确定预防的机会。
Background: Low socioeconomic status is associated with poor cardiovascular health. We evaluated the association between socioeconomic status and the incidence of sudden cardiac arrest, a condition that accounts for a substantial proportion of cardiovascular-related deaths, in seven large North American urban populations.Methods: Using a population-based registry, we collected data on out-of-hospital sudden cardiac arrests occurring at home or at a residential institution from Apr. 1, 2006, to Mar. 31, 2007. We limited the analysis to cardiac arrests in seven metropolitan areas in the United States (Dallas, Texas; Pittsburgh, Pennsylvania; Portland, Oregon; and Seattle-King County, Washington) and Canada (Ottawa and Toronto, Ontario; and Vancouver, British Columbia). Each incident was linked to a census tract; tracts were classified into quartiles of median household income.Results: A total of 9235 sudden cardiac arrests were included in the analysis. For all sites combined, the incidence of sudden cardiac arrest in the lowest socioeconomic quartile was nearly double that in the highest quartile (incidence rate ratio [IRR] 1.9, 95% confidence interval [CI] 1.8-2.0). This disparity was greater among people less than 65 years old (IRR 2.7, 95% CI 2.5-3.0) than among those 65 or older (IRR 1.3, 95% CI 1.2-1.4). After adjustment for study site and for population age structure of each census tract, the disparity across socio economic quartiles for all ages combined was greater in the United States (IRR 2.0, 95% CI 1.9-2.2) than in Canada (IRR 1.8, 95% CI 1.6-2.0) (p < 0.001 for interaction).Interpretation: The incidence of sudden cardiac arrest at home or at a residential institution was higher in poorer neighbourhoods of the US and Canadian sites studied, although the association was attenuated in Canada. The disparity across socioeconomic quartiles was greatest among people younger than 65. The association be tween socio economic status and incidence of sudden cardiac arrest merits consideration in the development of strategies to improve survival from sudden cardiac arrest, and possibly to identify opportunities for prevention.