Differences in the rates of bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest resulting in favourable neurological outcomes according to the regional deprivation index
Abstract
Background Variability in the provision of bystander cardiopulmonary resuscitation (BCPR) may influence neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) according to regional socioeconomic factors. We aimed to investigate the association between BCPR and neurological outcomes of OHCA and whether these associations differ across regions with different levels of deprivation. Methods Using data collected from the Korean National OHCA Registry between 2013 and 2023, adults (≥18 years of age) with OHCA of presumed cardiac origin were identified. The main exposure variable was BCPR and the regional deprivation index. The primary outcome was a favourable neurological outcome, defined as a Cerebral Performance Category score of 1 or 2. Multivariate logistic regression was used to evaluate the associations between BCPR and favourable neurological outcomes and to assess the interaction between BCPR and regional deprivation index. Results Of 184,727 individuals who experienced OHCA, 112,728 (61.0%) received BCPR. There were differences in the rate of BCPR according to regional deprivation group: high, 57.9%; moderate, 59.9%; and low, 62.6%. In total, 10,669 (5.8%) patients experienced favourable neurological outcomes. Multivariable models revealed different associations between BCPR and favourable neurological outcomes according to regional deprivation level: high, adjusted odds ratio (OR) 1.56 (95% confidence interval [CI] 1.23–1.99); moderate, 1.31 (95% CI 1.19–1.44); and low, 1.34 (95% CI 1.23–1.45). The magnitude of the association showed a significant interaction (p < 0.01). Conclusions Although high-deprivation regions had lower BCPR rates, the association between BCPR and favourable neurological outcomes was stronger in high-deprivation regions than in moderate- and low-deprivation regions. Multifaceted interventions are needed to increase BCPR rates in highly deprived regions.