Association Between Urban-Rural Geographical Location and 30-Day Survival After Out-of-Hospital Cardiac Arrest

The aim of this study is to investigate the association between the urban-rural geographical location of out-of-hospital cardiac arrest (OHCA) and 30-day survival after OHCA in Scotland.

For these analyses, data from a population-based study were utilized. In this cohort, all adult, nonemergency medical services (EMS)-witnessed patients with nontraumatic OHCA, for whom the Scottish Ambulance Service attempted resuscitation between April 1, 2011, and March 1, 2020, were included. We used the 2-fold and 6-fold urban-rural classification determined by the Scottish Government to classify cases in our cohort. We used 30-day survival after OHCA as an outcome measure. We performed univariable and multivariable logistic regression to assess the association between urban-rural geographical locations of OHCA and 30-day survival after OHCA. Furthermore, we conducted a mediation analysis to identify potential mediators.

This cohort included 20,378 OHCA cases. Patients living in rural areas have a lower odds of 30-day survival after OHCA compared with people living in urban areas (adjusted odds ratio, 1.19; 95% CI, 1.02 to 1.40; adjusted for age, sex, and the Scottish Index of Multiple Deprivation. Early EMS arrival time (a likely proxy for time to first defibrillation) was associated with improved 30-day survival after OHCA and was identified as a probable mediator explaining part of the association found between urban-rural geographical location of OHCA and 30-day survival after OHCA.

Policies focusing on reducing time to first defibrillation are likely to be most effective in reducing the difference in 30-day survival after OHCA between urban and rural communities.