Low household income associated with increased risk for out-of-hospital cardiac arrest
Click Here to Manage Email Alerts
A population-level study conducted by researchers in the Netherlands showed a significant association between household income and risk for out-of-hospital cardiac arrest.
The findings of the retrospective cohort study were published in Circulation: Cardiovascular Quality and Outcomes.
Source: Adobe Stock
“We find a consistent, graded association between low household and personal income and higher risk of out-of-hospital cardiac arrest in women and men aged 25 years or older,” Benjamin P. van Nieuwenhuizen, PhD, of the department of public and occupational health at Amsterdam University Medical Center, and colleagues wrote. “The graded association was also found when excluding short follow-up times. This provides improved evidence that lower income may increase the risk for out-of-hospital cardiac arrest. This implies low-income groups to be a suitable target for resuscitative training efforts as well as primary prevention strategies focusing on out-of-hospital cardiac arrest.”
Using the Amsterdam Resuscitation Studies (ARREST) registry, van Nieuwenhuizen and colleagues conducted a retrospective study of more than 1.6 million adults aged at least 25 years living in the registry catchment area in a Dutch province.
At total of 5,493 cases of out-of-hospital cardiac arrest were linked using separate demographic and income registries.
Participants were stratified into quintiles based on household income: The first quintile included those with the highest household income and the fifth including those with the lowest household income.
Median age of the study population was 49 years for women and 48 years for men. Median age at time of out-of-hospital cardiac arrest was 70 years for women and 65 years for men.
During a mean follow-up of 2,395 days, the total incidence per 100,000 person-years of out-of-hospital cardiac arrest was 30.9 in women and 87.1 in men.
Compared with participants in the highest quintile of household income, researchers estimated that the HR for out-of-hospital cardiac arrest among participants in the second highest to lowest household quintiles ranged from 1.24 (95% CI, 1.01-1.51) to 1.75 (95% CI, 1.46-2.1) in women and 0.95 (95% CI, 0.68-1.34) to 2.3 (95% CI, 1.74-3.05) in men.
When the lower four quintiles of personal income — rather than household — were compared with the highest quintile, the HR for out-of-hospital cardiac arrest ranged from 0.95 (95% CI, 0.68-1.34) to 2.3 (95% CI, 1.74-3.05) for women and 1.28 (95% CI, 1.16-1.42) and 1.68 (95% CI, 1.48-1.89) for men, according to the study.
Moreover, the findings of additional analyses that excluded early follow-up times, individuals with comorbidities and featured a decreased catchment area and broader definition of sudden cardiac death showed similar results compared with the main analysis.
“While we hypothesized that low income may lead to an increased risk of out-of-hospital cardiac arrest, it is possible that the causal effect flows the opposite way, that is, that poor health may influence level of income. If poor health leads to disability, this may lead to job loss or a decrease in working hours and, hence, income,” the researchers wrote. “Additionally, consistent findings in the analyses excluding individuals with comorbidities at baseline further also supports social causation.”
Collapse
Click Here to Manage Email Alerts