Ethnic and Neighborhood Socioeconomic Differences In Incidence and Survival From Out-Of-Hospital Cardiac Arrest In Singapore

Abstract

Objective: We aimed to examine the association of ethnicity and socioeconomic status (SES) with Out-of-Hospital Cardiac Arrest (OHCA) incidence and 30-day survival in Singapore. Methods: We analyzed the Singapore cohort of Pan-Asia Resuscitation Outcome Study (PAROS), a multi-center, prospective OHCA registry between 2010 and 2015. The Singapore Socioeconomic Disadvantage Index (SEDI) score, obtained according to zip code, was used as surrogate for neighborhood SES. Age-adjusted OHCA incidence and Utstein survival were calculated by ethnicity and SES. Utstein survival was defined as the number of cardiac OHCA cases with initial rhythm of ventricular fibrillation witnessed by a bystander who survived 30-days or until hospital discharge. Logistic regression was used to investigate association of ethnicity with 30-day and Utstein survivals. Results: Our study population comprised 8,900 patients: 6,453 Chinese, 1,472 Malays, and 975 Indians. The overall age-adjusted incidence ratios (95% CI) for Malay/Chinese and Indian/Chinese were 1.93 (1.83–2.04) and 1.95 (1.83–2.08), respectively. The overall age-adjusted incidence ratios (95% CI) for average/low and high/low SEDI group were 1.12 (0.95–1.33) and 1.29 (1.08–1.53), respectively. Malay showed lesser Utstein survival of 8.1% compared to Chinese (14.6%) and Indian (20.4%) [p = 0.018]. Ethnicity did not reach statistical significance (p = 0.072) in forward selection model of Utstein survival, while SEDI score and category were not significant (p > 0.2 and p = 0.349). Conclusions: We found Malay and Indian communities to be at higher risks of OHCA compared to Chinese, and additionally, the Malay community is at higher risk of subsequent mortality than the Chinese and Indian communities. These disparities were not explained by neighborhood SES.

Key words:

• cardiac arrest
• ethnicity
• socio-economic status
• resuscitation
• mortality