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Does location matter? A proposed methodology to evaluate neighbourhood effects on cardiac arrest survival and bystander CPR

  • Jason E. Buick (a1) (a2), Katherine S. Allan (a3) (a4), Joel G. Ray (a2) (a5) (a6), Alexander Kiss (a2) (a7), Paul Dorian (a1) (a4) (a5) (a6), Peter Gozdyra (a5) (a7) and Laurie J. Morrison (a1) (a2) (a3) (a6) (a8)...

Abstract

Background

Traditional variables used to explain survival following out-of-hospital cardiac arrest (OHCA) account for only 72% of survival, suggesting that other unknown factors may influence outcomes. Research on other diseases suggests that neighbourhood factors may partly determine health outcomes. Yet, this approach has rarely been used for OHCA. This work outlines a methodology to investigate multiple neighbourhood factors as determinants of OHCA outcomes.

Methods

A retrospective, observational cohort study design will be used. All adult non-emergency medical service witnessed OHCAs of cardiac etiology within the city of Toronto between 2006 and 2010 will be included. Event details will be extracted from the Toronto site of the Resuscitation Outcomes Consortium Epistry—Cardiac Arrest, an existing population-based dataset of consecutive OHCA patients. Geographic information systems technology will be used to assign patients to census tracts. Neighbourhood variables to be explored include the Ontario Marginalization Index (deprivation, dependency, ethnicity, and instability), crime rate, and density of family physicians. Hierarchical logistic regression analysis will be used to explore the association between neighbourhood characteristics and 1) survival-to-hospital discharge, 2) return-of-spontaneous circulation at hospital arrival, and 3) provision of bystander cardiopulmonary resuscitation (CPR). Receiver operating characteristics curves will evaluate each model’s ability to discriminate between those with and without each outcome.

Discussion

This study will determine the role of neighbourhood characteristics in OHCA and their association with clinical outcomes. The results can be used as the basis to focus on specific neighbourhoods for facilitating educational interventions, CPR awareness programs, and higher utilization of automatic defibrillation devices.

Contexte

Les variables classiques ne permettent d’expliquer que 72 % de la survie des malades à la suite d’un arrêt cardiaque extrahospitalier (ACEH), ce qui donne à penser que d’autres facteurs inconnus peuvent influer sur les résultats. Des recherches sur d’autres maladies semblent indiquer que des facteurs relatifs aux quartiers peuvent déterminer en partie les résultats cliniques. Pourtant, ce type de recherche a rarement été appliqué au contexte des ACEH. Sera exposée ici une méthode visant à étudier différents facteurs relatifs aux quartiers et à les considérer comme des déterminants de résultats cliniques après un ACEH.

Méthode

Pour ce faire, nous avons mené une étude de cohortes, rétrospective et observationnelle. Ont été retenus tous les adultes non rattachés à des services médicaux d’urgence, témoins d’un ACEH d’origine cardiaque, survenu dans la ville de Toronto entre 2006 et 2010. Les renseignements sur les faits ont été tirés du site Resuscitation Outcomes Consortium Epistry – Cardiac Arrest, une base de données déjà existante, située à Toronto, fondée sur une population composée de malades consécutifs ayant subi un ACEH. Pour ce qui est de la localisation, des systèmes d'information géographique ont été utilisés pour lier les malades à des secteurs de recensement. Les variables relatives aux quartiers devant être examinées comprenaient l’Ontario Marginalization Index (indice de marginalisation de l’Ontario; privations, dépendance, origine ethnique et instabilité), le taux de criminalité et la densité des omnipraticiens. Une analyse de régression logistique hiérarchique a servi à étudier l’association entre les caractéristiques des quartiers et 1) la survie jusqu’au congé de l’hôpital; 2) le rétablissement spontané de la circulation sanguine à l’arrivée à l’hôpital; et 3) les manœuvres de réanimation cardiorespiratoire (RCR) appliquées par les passants. Des courbes caractéristiques de la performance des tests ont permis d’évaluer la capacité du modèle à discerner les variables qui comportaient ou non l’un ou l’autre des résultats d’intérêt.

Discussion

L’étude permettra de déterminer le rôle des quartiers dans le contexte des ACEH et d’établir des associations avec les résultats cliniques. Les faits dégagés pourront servir de base à la caractérisation des quartiers afin de faciliter les interventions éducatives, la mise en œuvre des programmes de sensibilisation à la RCR et l’utilisation accrue des appareils de défibrillation automatique.

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Copyright

Corresponding author

Correspondence to: Jason Buick, Rescu, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8; Email: buickj@smh.ca; Dr. Laurie Morrison, Rescu, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8; Email: morrisonL@smh.ca

References

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1. Roger, VL, Go, AS, Lloyd-Jones, DM, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation 2012;125(1):e2-e220.
2. Nichol, G, Thomas, E, Callaway, CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008;300(12):1423-1431.
3. Sasson, C, Rogers, MA, Dahl, J, et al. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3(1):63-81.
4. Weisfeldt, ML, Sitlani, CM, Ornato, JP, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol 2010;55(16):1713-1720.
5. Travers, AH, Rea, TD, Bobrow, BJ, et al. Part 4: CPR overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S676-S684.
6. Jacobs, I, Nadkarni, V, Bahr, J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 2004;63(3):233-249.
7. Rea, TD, Cook, AJ, Stiell, IG, et al. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. Ann Emerg Med 2010;55(3):249-257.
8. Clarke, SO, Schellenbaum, GD, Rea, TD. Socioeconomic status and survival from out-of-hospital cardiac arrest. Acad Emerg Med 2005;12(10):941-947.
9. Hallstrom, A, Boutin, P, Cobb, L, et al. Socioeconomic status and prediction of ventricular fibrillation survival. Am J Public Health 1993;83(2):245-248.
10. Vaillancourt, C, Lui, A, De Maio, VJ, et al. Socioeconomic status influences bystander CPR and survival rates for out-of-hospital cardiac arrest victims. Resuscitation 2008;79(3):417-423.
11. Mitchell, MJ, Stubbs, BA, Eisenberg, MS. Socioeconomic status is associated with provision of bystander cardiopulmonary resuscitation. Prehosp Emerg Care 2009;13(4):478-486.
12. Sasson, C, Keirns, CC, Smith, DM, et al. Examining the contextual effects of neighborhood on out-of-hospital cardiac arrest and the provision of bystander cardiopulmonary resuscitation. Resuscitation 2011;82(6):674-679.
13. Sasson, C, Magid, DJ, Chan, P, et al. Association of neighborhood characteristics with bystander-initiated CPR. N Engl J Med 2012;367(17):1607-1615.
14. Sayegh, AJ, Swor, R, Chu, KH, et al. Does race or socioeconomic status predict adverse outcome after out of hospital cardiac arrest: a multi-center study. Resuscitation 1999;40(3):141-146.
15. Cowie, MR, Fahrenbruch, CE, Cobb, LA, et al. Out-of-hospital cardiac arrest: racial differences in outcome in Seattle. Am J Public Health 1993;83(7):955-959.
16. Becker, LB, Han, BH, Meyer, PM, et al. Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project. N Engl J Med 1993;329(9):600-606.
17. Galea, S, Blaney, S, Nandi, A, et al. Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest. Am J Epidemiol 2007;166(5):534-543.
18. Chu, K, Swor, R, Jackson, R, et al. Race and survival after out-of-hospital cardiac arrest in a suburban community. Ann Emerg Med 1998;31(4):478-482.
19. Vadeboncoeur, TF, Richman, PB, Darkoh, M, et al. Bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest in the Hispanic vs the non-Hispanic populations. Am J Emerg Med 2008;26(6):655-660.
20. Shah, AS, Bhopal, R, Gadd, S, et al. Out-of-hospital cardiac arrest in South Asian and white populations in London: database evaluation of characteristics and outcome. Heart 2010;96(1):27-29.
21. Brookoff, D, Kellermann, AL, Hackman, BB, et al. Do blacks get bystander cardiopulmonary resuscitation as often as whites? Ann Emerg Med 1994;24(6):1147-1150.
22. Benson, PC, Eckstein, M, McClung, CD, et al. Racial/ethnic differences in bystander CPR in Los Angeles, California. Ethn Dis 2009;19(4):401-406.
23. Iwashyna, TJ, Christakis, NA, Becker, LB. Neighborhoods matter: a population-based study of provision of cardiopulmonary resuscitation. Ann Emerg Med 1999;34(4 Pt 1):459-468.
24. McNally, B, Robb, R, Mehta, M, et al. Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. MMWR Surveill Summ 2011;60(8):1-19.
25. Diez Roux, AV. Investigating neighborhood and area effects on health. Am J Public Health 2001;91(11):1783-1789.
26. Ahn, KO, Shin, SD, Hwang, SS, et al. Association between deprivation status at community level and outcomes from out-of-hospital cardiac arrest: a nationwide observational study. Resuscitation 2011;82(3):270-276.
27. Braveman, PA, Cubbin, C, Egerter, S, et al. Socioeconomic status in health research: one size does not fit all. JAMA 2005;294(22):2879-2888.
28. Morrison, LJ, Nichol, G, Rea, TD, et al. Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Resuscitation 2008;78(2):161-169.
29. Statistics Canada. Classification of age categories by five-year age groups. Ottawa Statistics Canada; 2010, Available at: http://www.statcan.gc.ca/concepts/definitions/class-age1-eng.htm (accessed January 31, 2012).
30. Health PCCF+ [database]. Statistics Canada - Geography Division. 2010. Available at: http://datalib.chass.utoronto.ca/codebooks/cstdli/pccf.htm (accessed October 25 2011).
31. Statistics Canada. Census tract (CT). Ottawa Statistics Canada; 2009, Available at: http://www12.statcan.ca/census-recensement/2006/ref/dict/geo013-eng.cfm (accessed August 29, 2011).
32. Nichol, G, Stiell, IG, Laupacis, A, et al. A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest. Ann Emerg Med 1999;34(4 Pt 1):517-525.
33. Leal, C, Chaix, B. The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda. Obes Rev 2011;12(3):217-230.
34. Pickett, KE, Pearl, M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health 2001;55(2):111-122.
35. Matheson, FI, LaFreniere, MC, White, HL, et al. Influence of neighborhood deprivation, gender and ethno-racial origin on smoking behavior of Canadian youth. Prev Med 2011;52(5):376-380.
36. Matheson, FI, White, HL, Moineddin, R, et al. Drinking in context: the influence of gender and neighbourhood deprivation on alcohol consumption. J Epidemiol Community Health 2012;66(6):e4.
37. Winkleby, M, Sundquist, K, Cubbin, C. Inequities in CHD incidence and case fatality by neighborhood deprivation. Am J Prev Med 2007;32(2):97-106.
38. Alter, DA, Austin, PC, Tu, JV. Community factors, hospital characteristics and inter-regional outcome variations following acute myocardial infarction in Canada. Can J Cardiol 2005;21(3):247-255.
39. Tonne, C, Schwartz, J, Mittleman, M, et al. Long-term survival after acute myocardial infarction is lower in more deprived neighborhoods. Circulation 2005;111(23):3063-3070.
40. Fisher, KJ, Li, F, Michael, Y, et al. Neighborhood-level influences on physical activity among older adults: a multilevel analysis. J Aging Phys Act 2004;12(1):45-63.
41. Black, JL, Macinko, J. Neighborhoods and obesity. Nutr Rev 2008;66(1):2-20.
42. Mujahid, MS, Diez Roux, AV, Morenoff, JD, et al. Neighborhood characteristics and hypertension. Epidemiology 2008;19(4):590-598.
43. Auchincloss, AH, Diez Roux, AV, Mujahid, MS, et al. Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: the multi-ethnic study of atherosclerosis. Arch Intern Med 2009;169(18):1698-1704.
44. Mair, C, Diez Roux, AV, Galea, S. Are neighbourhood characteristics associated with depressive symptoms? A review of evidence. J Epidemiol Community Health 2008;62(11):940-946, 8 p following 6.
45. Larson, NI, Story, MT, Nelson, MC. Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med 2009;36(1):74-81.
46. Govindarajan, A, Schull, M. Effect of socioeconomic status on out-of-hospital transport delays of patients with chest pain. Ann Emerg Med 2003;41(4):481-490.
47. Earnest, A, Tan, SB, Shahidah, N, et al. Geographical variation in ambulance calls is associated with socioeconomic status. Acad Emerg Med 2012;19(2):180-188.
48. Grossman, DC, Kim, A, Macdonald, SC, et al. Urban-rural differences in prehospital care of major trauma. J Trauma 1997;42(4):723-729.
49. Canada Post. Canada Post - Find a Postal Code. Ottawa Canada Post Corporation; 2011, Available at: http://www.canadapost.ca/cpotools/apps/fpc/personal/findByCity?execution=e1s1 (accessed September 21, 2011).
50. GeoCoder.ca - Location Intelligence Works. Geocorder.ca: Geocoding for North America. Ottawa, Ontario Geocoder.ca; 2011, Available at: http://www.geocoder.ca/ (accessed May 7, 2011).
51. Matheson, FI, Dunn, JR, Smith, KLW, et al. Development of the Canadian Marginalization Index: a new tool for the study of inequality. Can J Public Health 2012;103(Suppl. 2):(8): eS12-eS16.
52. Violent Crime Rate [database]. 2006. Available at: http://www.stmichaelshospital.com/crich/ (accessed June 7, 2011).
53. Toronto Family Physicians by Census Tract [database]. 2006, Available at: http://www.ices.on.ca (accessed June 23, 2011).
54. Cook, NR. Use and misuse of the receiver operating characteristic curve in risk prediction. Circulation 2007;115(7):928-935.
55. Statistics Canada. Census: dat a quality verification in place for the 2006 census . Ottawa Statistics Canada; 2009. Available at: http://www12.statcan.ca/census-recensement/2006/ref/index-eng.cfm (accessed September 21, 2011).

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