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Rurality and Area Deprivation and Outcomes After Out-of-Hospital Cardiac Arrest.

Lakota Cheek1, Robert H Schmicker2, Remle Crowe3

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Outcomes after out-of-hospital cardiac arrest (OHCA) are worse in rural and economically deprived areas. Emergency medical services (EMS) interventions show reduced success rates in these regions, highlighting disparities in care.

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Area of Science:

  • Public Health
  • Emergency Medicine
  • Health Services Research

Background:

  • Significant regional disparities exist in outcomes for out-of-hospital cardiac arrest (OHCA) patients.
  • Understanding the impact of socioeconomic and geographic factors on emergency medical services (EMS) is crucial for improving patient care.

Purpose of the Study:

  • To investigate the association between neighborhood rurality and economic deprivation with EMS outcomes following OHCA.
  • To identify geographic variations in emergency response and patient survival rates.

Main Methods:

  • A retrospective cohort study utilizing data from ESO Inc. on adult OHCA patients (January 2022 - December 2023).
  • Rurality assessed via Rural-Urban Commuting Area codes and deprivation via Area Deprivation Index, both linked to EMS agency data.
  • Generalized estimating equations used to analyze outcomes including restoration of spontaneous circulation (ROSC), survival to discharge, and favorable discharge destination.

Main Results:

  • OHCAs in rural areas, regardless of deprivation level, showed lower odds of ROSC upon emergency department (ED) arrival compared to urban, low-deprivation areas.
  • Patients in urban areas with high or moderate deprivation had reduced odds of survival and favorable discharge destination.
  • These findings suggest poorer neurological outcomes in more deprived and rural settings.

Conclusions:

  • Geographic and socioeconomic factors significantly impact OHCA outcomes, with rural and deprived areas experiencing worse results.
  • Existing care improvement strategies may not be sufficient to overcome these deep-seated geographic disparities.
  • Further research is needed to address systemic inequities in emergency medical care access and quality.