Int J Health Geogr - Population density, call-response interval, and survival of out-of-hospital cardiac arrest.

Tópicos

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Resumo

CKGROUND: Little is known about the effects of geographic variation on outcomes of out-of-hospital cardiac arrest (OHCA). The present study investigated the relationship between population density, time between emergency call and ambulance arrival, and survival of OHCA, using the All-Japan Utstein-style registry database, coupled with geographic information system (GIS) data.METHODS: We examined data from 101,287 bystander-witnessed OHCA patients who received emergency medical services (EMS) through 4,729 ambulatory centers in Japan between 2005 and 2007. Latitudes and longitudes of each center were determined with address-match geocoding, and linked with the Population Census data using GIS. The endpoints were 1-month survival and neurologically favorable 1-month survival defined as Glasgow-Pittsburgh cerebral performance categories 1 or 2.RESULTS: Overall 1-month survival was 7.8%. Neurologically favorable 1-month survival was 3.6%. In very low-density (<250/km(2)) and very high-density (=10,000/km(2)) areas, the mean call-response intervals were 9.3 and 6.2 minutes, 1-month survival rates were 5.4% and 9.1%, and neurologically favorable 1-month survival rates were 2.7% and 4.3%, respectively. After adjustment for age, sex, cause of arrest, first aid by bystander and the proportion of neighborhood elderly people =65 yrs, patients in very high-density areas had a significantly higher survival rate (odds ratio (OR), 1.64; 95% confidence interval (CI), 1.44 - 1.87; p < 0.001) and neurologically favorable 1-month survival rate (OR, 1.47; 95%CI, 1.22 - 1.77; p < 0.001) compared with those in very low-density areas.CONCLUSION: Living in a low-density area was associated with an independent risk of delay in ambulance response, and a low survival rate in cases of OHCA. Distribution of EMS centers according to population size may lead to inequality in health outcomes between urban and rural areas.

Resumo Limpo

ckground littl known effect geograph variat outcom outofhospit cardiac arrest ohca present studi investig relationship popul densiti time emerg call ambul arriv surviv ohca use alljapan utsteinstyl registri databas coupl geograph inform system gis datamethod examin data bystanderwit ohca patient receiv emerg medic servic em ambulatori center japan latitud longitud center determin addressmatch geocod link popul census data use gis endpoint month surviv neurolog favor month surviv defin glasgowpittsburgh cerebr perform categori result overal month surviv neurolog favor month surviv lowdens km highdens km area mean callrespons interv minut month surviv rate neurolog favor month surviv rate respect adjust age sex caus arrest first aid bystand proport neighborhood elder peopl yrs patient highdens area signific higher surviv rate odd ratio confid interv ci p neurolog favor month surviv rate ci p compar lowdens areasconclus live lowdens area associ independ risk delay ambul respons low surviv rate case ohca distribut em center accord popul size may lead inequ health outcom urban rural area

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