Do People With Low Ses Background Receive The Same Medical Care As Those Who Are High Ses
Abstract
Aims
Individuals with low socioeconomic status (SES) face up widespread prejudice in society. Whether SES disparities exist in handling and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors.
Methods and results
In total, 24 217 IHCAs from the Swedish Annals of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, middle rhythm, aetiology, hospital, and yr, primary analyses showed that loftier (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with loftier SES were significantly more likely to survive CPR (loftier income: OR = 1.02), to survive to hospital discharge with expert neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = i.21; and high income: OR = one.05). Secondary analyses showed that patients with high SES were besides significantly more likely to receive rubber eye rhythm monitoring (highly educated: OR = i.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR filibuster.
Conclusion
There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.
See folio 870 for the editorial comment on this article (doi: )
Introduction
Sudden cardiac arrest (CA) is one of the leading causes of death in the Western earth, and around 1 1000000 people are estimated to suffer from CA annually in North America and Europe together. 1 Given its high prevalence, detecting, explaining, and combating group inequalities in CA handling and survival seems peculiarly important. Numerous studies have examined the association between socioeconomic status (SES) and survival afterwards out-of-hospital cardiac arrests (OHCA). This enquiry has generally found that patients with higher SES are more than likely to survive OHCA, 2–8 although some studies do not written report a human relationship. 9 , x Patients with college SES announced to be more likely to receive bystander cardiopulmonary resuscitation (CPR), which might partly explicate the positive overall relationship between SES and survival after OHCA. 6 , 11
Whether in that location are SES disparities in relation to in-hospital cardiac arrest (IHCA), however, is unclear. A recent review of the pocket-sized number of studies (N = 6) on the clan betwixt SES and IHCA outcomes reveals inconclusive results. 12 The included studies have primarily investigated outcomes like survival and neurological status at hospital discharge, leaving potential treatment differences largely unexplored. Moreover, nearly studies have non adjusted for of import medical confounders (east.g. comorbidity), which is problematic considering that lower SES is associated with poorer health. 13 As with about OHCA enquiry, some other limitation concerns the lack of adjustment for the patient'southward racial/ethnic background, which is problematic because the robust association betwixt SES and race/ethnicity. 9 , x Because race/ethnicity has been found to predict survival after both IHCA and OHCA, xiv–16 it could potentially confound whatsoever uncovered SES difference in treatment and survival. Additionally, existing IHCA studies have primarily originated from the USA. To our noesis, no European study on SES and IHCA has been reported. The lack of knowledge about the role of patient SES in the context of IHCA is noteworthy considering that IHCA is common, with an estimated incidence between one and 5 cases per 1000 hospital admissions. 17
Compared with OHCA, IHCA should put researchers in a ameliorate position to study the sources of SES differences in survival. Considering the afflicted patients are already in the hospital, an association between CA treatment and survival should less likely be due to structural SES differences in access to care (e.g. proximity of emergency medical services). 14 Furthermore, there should be more extensive, reliable, data near the patient and the IHCA event, giving researchers more control over potential SES confounding factors. Clarifying the sources of SES disparities is important for the development of successful interventions aimed at combating group inequalities. Socioeconomic status disparities in CA survival produced by differences in access to cardiopulmonary resuscitation (CPR) trained bystanders, underlying ethnicity, or pre-existing comorbidities, require different types of interventions than practice survival differences caused by medical staff providing differential treatment solely based on patient SES (bigotry).
The aim of the electric current retrospective registry written report was to examine SES disparities in IHCA treatment and survival, assessing SES at the individual (patient) level and adjusting for major demographic, clinical, and contextual factors.
Methods
The Swedish Register of Cardiopulmonary Resuscitation
This report used data from the Swedish Register of Cardiopulmonary Resuscitation (SRCR), a national quality registry whose aim is to facilitate prospective quality control of resuscitation practices in Sweden. The registry employs a predefined, Utstein-style reporting framework. The National Registry Committee continuously performs random inspections of the data to validate the registry.
The SRCR consists of 2 parts: IHCA and OHCA. The current study uses the IHCA registry, which contains individual-level data on patients who underwent CPR. Every bit of 2018, 73 out of 74 Swedish emergency hospitals written report IHCA data (Effigy1).
Effigy 1
Number of cardiac arrest events per infirmary.
The IHCA registry contains information on safety treatment (due east.g. heart rhythm monitoring), handling during the CA (e.g. CPR delay, CPR duration), immediate survival, survival to discharge from infirmary, 30-day survival, neurological part (cerebral performance category score; CPC) amidst survivors, and post-abort treatment. Additionally, it contains basic sociodemographic variables (gender and age), comorbidity, initial heart rhythm, probable aetiology of the CA, and contextual factors (east.thou. twelvemonth and infirmary). Finally, the registry includes the hospital staff'south own cess of the quality of the handling they provided during the CA (treatment satisfaction).
Statistics Sweden
Patient-level SES information were obtained from Statistics Sweden's LISA database. Ii primal SES proxies were used: highest level of completed pedagogy and annual income. 18 From LISA, we also obtained patient-level information on origin of birth (proxy for ethnicity).
Selection of patients
The electric current study included all patients, twoscore years or older, registered in the IHCA registry betwixt 2005 (start year) and xx August 2018 (extraction date) (Figuretwo). The rationale for the age criteria was that (i) SES proxies are not authentic for younger patients since many of them have not reached their highest income or level of completed education and (ii) these patients could be a selective group with unlike unobserved initial wellness due to the low CA prevalence for this age group.
Figure ii
Flowchart displaying choice of patients.
Variables
Outcome variables: CPR delay indicates the filibuster from discovery of the patient to the showtime of CPR (0 = <one min, 1 = 1 min or longer); CPR duration (minutes); Survival after CPR (0 = dead, 1 = alive); Treatment satisfaction reported by the medical staff (0 = unsatisfactory, 1 = satisfactory); Survival to hospital discharge with adept neurological outcome (i = CPC ≤ 2, indicating no, mild, or moderate neurological deficits, 0 = CPC iii–5, indicating severe neurological deficit, coma, or death); 30-day survival (0 = dead, 1 = alive).
Predictor variables (SES): Education (0 = high school or below, ane = college/university education). Income is a percentile score which reflects the patient'southward relative standing in the income distribution. Since many of the patients in the sample are retired, the income variable was based on ii types of income: annual earned income and retirement pension. The percentile score was based on either of the 2 types of income, depending on whether the patient was working or retired.
Control variables: Age; Gender; Ethnicity (Nordic, Western Europe, Southern Europe, Eastern Europe, Middle Eastern, African, Asian, South American, 'Other'); Hospital; Year; Comorbidity (previous history of middle failure, myocardial infarction, stroke, respiratory insufficiency, diabetes, cancer, and metastatic cancer); initial Heart rhythm (ventricular fibrillation, ventricular tachycardia, pulseless electric activity, or asystole); Aetiology of the CA (e.g. myocardial infarction/ischaemia, arrhythmia, heart failure, respiratory insufficiency, intoxication).
Statistical analysis
Fixed-effects regression models were estimated to account for the fact that the information are grouped on hospital and twelvemonth and that unobserved infirmary characteristics and time trends may affect outcomes and simultaneously be correlated with SES, potentially leading to omitted variable bias. The regressions included fixed furnishings for hospital (73 dummies as explanatory variables, i.e. one dummy for each hospital) and the yr of the CA event (one dummy for each year), in improver to the other control variables listed above. Logistic fixed-effects regression analysis was conducted to test for SES differences in relation to the dichotomous outcome variables (CPR delay, Survival later CPR, Treatment satisfaction, Survival to discharge with proficient neurological outcome, and xxx-mean solar day survival) and fixed-effects ordinary least squares regressions were estimated to analyse the continuous outcome variable (CPR elapsing). Separate analyses were performed with SES income and SES education (r = 0.309), respectively, as predictor variables. The level of statistical significance was prepare at P < 0.05. The statistical analysis was performed in Stata 16. 19
Results
Baseline characteristics
A majority of the patients had no CPR filibuster (59.1%). Cardiopulmonary resuscitation duration was on boilerplate 16.ii min (SD = 14.8). Half of the patients (51.six%) survived CPR. The medical staff reported beingness satisfied with the treatment provided in 71.8% of the cases. Ane-4th (23.1%) survived to discharge with adept neurological outcome, and ane-third (29.iv%) survived to 30 days (come across Tabular array1 for additional descriptive statistics).
Table one
Descriptive statistics (unadjusted) for the full sample and different socioeconomic status groups
| All | High SES (education) | Low SES (education) | SES income (4th quartile) | SES income (3rd quartile) | SES income (2nd quartile) | SES income (1st quartile) | |
|---|---|---|---|---|---|---|---|
| (n = 24 217) | (n = 3760) | (northward = twenty 457) | (n = 4733) | (due north = 4909) | (n = 4878) | (n = 4251) | |
| Historic period, mean (SD) | 73.half dozen (11.6) | seventy.9 (11.8) | 74.1 (xi.5) | 72.vii (10.7) | 74.6 (10.4) | 76.0 (10.1) | 77.7 (11.0) |
| Gender, n (%) | |||||||
| Female | 9287 (38.4) | 1227 (32.half dozen) | 8060 (39.iv) | 597 (12.6) | 1062 (21.6) | 2434 (49.9) | 3081 (72.5) |
| Male | xiv 930 (61.7) | 2533 (67.4) | 12 397 (60.6) | 4136 (87.4) | 3847 (78.4) | 2444 (fifty.ane) | 1170 (27.v) |
| Ethnic background, northward (%) | |||||||
| Nordic | 22 266 (91.9) | 3404 (90.five) | 18 862 (92.2) | 4532 (95.8) | 4641 (94.5) | 4582 (93.3) | 3764 (88.5) |
| Africa | 110 (0.5) | xix (0.5) | 91 (0.iv) | xiii (0.8) | 9 (0.2) | 7 (0.1) | 25 (0.6) |
| Asia | 146 (0.vi) | 42 (1.1) | 104 (0.5) | 17 (0.four) | 10 (0.two) | 17 (0.iv) | 40 (0.94) |
| Eastern Europe | 393 (1.6) | 92 (ii.iv) | 301 (1.5) | 60 (1.3) | 85 (one.73) | 69 (1.4) | 81 (1.ix) |
| Middle Due east | 437 (1.8) | 80 (two.1) | 357 (1.8) | 14 (0.3) | 24 (0.5) | 29 (0.six) | 148 (3.5) |
| Southward Europe | 469 (1.9) | 46 (1.ii) | 423 (2.0) | 28 (0.6) | 68 (one.4) | 89 (1.8) | 122 (2.9) |
| Western Europe | 338 (i.4) | 69 (ane.8) | 269 (one.3) | 64 (ane.4) | 67 (1.36) | 71 (1.5) | 56 (1.3) |
| Other | 58 (0.2) | 8 (0.2) | 50 (0.ii) | 5 (0.ane) | five (0.1) | 14 (0.29) | 15 (0.4) |
| Comorbidity index (0–7), hateful (SD) | ane.38 (1.xix) | i.22 (1.17) | 1.41 (1.19) | 1.36 (1.19) | 1.49 (1.21) | 1.45 (one.xviii) | ane.37 (one.16) |
| Initial centre rhythm, northward (%) | |||||||
| Ventricular fibrillation | 3938 (xvi.3) | 700 (eighteen.6) | 3238 (15.8) | 956 (xx.0) | 867 (17.vii) | 734 (xv.i) | 547 (12.9) |
| Ventricular tachycardia | 1565 (6.5) | 297 (7.9) | 1268 (half-dozen.2) | 378 (7.99) | 332 (half dozen.76) | 288 (5.9) | 196 (4.6) |
| Pulseless electrical activity | 4785 (nineteen.8) | 729 (19.4) | 4056 (19.8) | 825 (17.4) | 944 (19.2) | 977 (twenty.0) | 799 (18.8) |
| Asystole | 7788 (32.2) | 1167 (31.0) | 6621 (32.4) | 1407 (29.vii) | 1531 (31.2) | 1615 (33.1) | 1502 (35.three) |
| Missing | 6141 (25.4) | 867 (23.ane) | 5274 (25.eight) | 1167 (24.7) | 1235 (25.ii) | 1264 (25.ix) | 1207 (29.4) |
| Cardiac aetiology, n (%) | |||||||
| Yes | 11 514 (47.6) | 1775 (47.two) | 9739 (47.6) | 2427 (51.3) | 2481 (fifty.five) | 2400 (49.ii) | 1993 (46.ix) |
| No | 2281 (ix.4) | 359 (9.vi) | 1922 (9.4) | 350 (7.iv) | 412 (8.4) | 407 (viii.3) | 358 (eight.4) |
| Missing | 10 422 (43.0) | 1626 (43.2) | 8796 (43.0) | 1956 (41.3) | 2016 (41.1) | 2071 (42.5) | 1900 (44.7) |
| Monitored, n (%) | |||||||
| Yes | 12 502 (51.6) | 2142 (57.0) | 10 360 (50.6) | 2592 (54.8) | 2627 (53.5) | 2411 (49.4) | 2009 (47.iii) |
| No | 11 360 (46.9) | 1555 (41.4) | 9805 (47.nine) | 2068 (43.vii) | 2222 (45.3) | 2396 (49.1) | 2194 (51.6) |
| Missing | 355 (one.five) | 63 (1.7) | 292 (one.43) | 73 (1.5) | 60 (one.22) | 71 (1.5) | 48 (1.13) |
| CPR delay, n (%) | |||||||
| Yeah | 6118 (25.iii) | 842 (22.4) | 5276 (25.8) | 1094 (23.one) | 1224 (24.9) | 1295 (26.half dozen) | 1139 (26.8) |
| No | 14 303 (59.i) | 2325 (61.8) | xi 978 (58.6) | 2854 (60.three) | 2883 (58.vii) | 2829 (58.0) | 2506 (59.0) |
| Missing | 3796 (15.vii) | 593 (15.8) | 3203 (15.seven) | 785 (sixteen.6) | 802 (sixteen.3) | 754 (15.5) | 606 (14.3) |
| CPR elapsing in minutes, mean (SD) | 16.2 (14.8) | 15.viii (15.ane) | 16.3 (14.8) | xvi.6 (xvi.0) | 16.2 (14.ii) | xv.9 (xiv.3) | 15.viii (14.iv) |
| Missing, northward (%) | 14 561 (60.one) | 2135 (56.8) | 12 426 (threescore.7) | 3169 (67.0) | 3194 (65.1) | 3274 (67.one) | 2863 (67.4) |
| Survival after CPR, north (%) | |||||||
| Yes | 12 503 (51.half-dozen) | 2128 (56.half dozen) | ten 375 (fifty.7) | 2601 (55.0) | 2524 (51.4) | 2370 (48.6) | 1985 (46.vii) |
| No | eleven 714 (48.4) | 1632 (43.4) | ten 082 (49.3) | 2132 (45.0) | 2385 (48.half-dozen) | 2508 (51.four) | 2266 (53.3) |
| Treatment satisfaction, n (%) | |||||||
| Yes | 17 378 (71.8) | 2699 (71.8) | 14 679 (71.eight) | 3358 (71.0) | 3541 (72.1) | 3546 (72.vii) | 3067 (72.2) |
| No | 6839 (28.ii) | 1061 (28.ii) | 5778 (28.2) | 1375 (29.0) | 1368 (27.9) | 1332 (27.3) | 1184 (27.9) |
| Survival to belch with adept neurological outcome, n (%) | |||||||
| Yep | 5597 (23.1) | 1127 (30.0) | 4470 (21.9) | 1333 (28.2) | 1150 (23.4) | 991 (20.3) | 745 (17.5) |
| No | sixteen 839 (69.5) | 2362 (62.8) | xiv 477 (70.8) | 3147 (66.5) | 3528 (71.ix) | 3667 (75.2) | 3314 (78.0) |
| Missing | 1781 (vii.four) | 271 (seven.2) | 1510 (vii.4) | 253 (5.4) | 231 (iv.7) | 220 (4.5) | 192 (4.five) |
| thirty-twenty-four hour period survival, northward (%) | |||||||
| Yes | 7130 (29.4) | 1387 (36.9) | 5743 (28.0) | 1648 (34.8) | 1450 (29.v) | 1283 (26.3) | 997 (23.5) |
| No | 17 087 (seventy.6) | 2373 (63.1) | 14 714 (71.nine) | 3085 (65.2) | 3459 (70.v) | 3595 (73.7) | 3254 (76.6) |
| All | High SES (education) | Depression SES (education) | SES income (4th quartile) | SES income (tertiary quartile) | SES income (2nd quartile) | SES income (1st quartile) | |
|---|---|---|---|---|---|---|---|
| (n = 24 217) | (n = 3760) | (due north = 20 457) | (n = 4733) | (north = 4909) | (n = 4878) | (n = 4251) | |
| Historic period, mean (SD) | 73.6 (11.six) | 70.9 (11.8) | 74.i (11.5) | 72.seven (10.7) | 74.6 (x.4) | 76.0 (10.one) | 77.7 (eleven.0) |
| Gender, n (%) | |||||||
| Female person | 9287 (38.four) | 1227 (32.6) | 8060 (39.4) | 597 (12.6) | 1062 (21.6) | 2434 (49.ix) | 3081 (72.five) |
| Male person | 14 930 (61.7) | 2533 (67.4) | 12 397 (60.6) | 4136 (87.iv) | 3847 (78.4) | 2444 (50.1) | 1170 (27.v) |
| Ethnic background, north (%) | |||||||
| Nordic | 22 266 (91.9) | 3404 (xc.5) | 18 862 (92.2) | 4532 (95.8) | 4641 (94.5) | 4582 (93.3) | 3764 (88.5) |
| Africa | 110 (0.5) | nineteen (0.5) | 91 (0.4) | xiii (0.8) | ix (0.2) | 7 (0.1) | 25 (0.six) |
| Asia | 146 (0.half-dozen) | 42 (ane.one) | 104 (0.5) | 17 (0.4) | 10 (0.2) | 17 (0.4) | forty (0.94) |
| Eastern Europe | 393 (1.half-dozen) | 92 (2.4) | 301 (1.v) | 60 (i.3) | 85 (1.73) | 69 (1.four) | 81 (1.9) |
| Middle East | 437 (1.8) | lxxx (two.1) | 357 (one.8) | 14 (0.3) | 24 (0.5) | 29 (0.6) | 148 (iii.v) |
| South Europe | 469 (1.nine) | 46 (ane.ii) | 423 (2.0) | 28 (0.6) | 68 (i.4) | 89 (one.eight) | 122 (2.9) |
| Western Europe | 338 (one.4) | 69 (1.8) | 269 (1.iii) | 64 (1.4) | 67 (one.36) | 71 (1.five) | 56 (one.3) |
| Other | 58 (0.two) | eight (0.2) | l (0.2) | v (0.1) | 5 (0.one) | 14 (0.29) | 15 (0.iv) |
| Comorbidity alphabetize (0–7), mean (SD) | 1.38 (1.19) | 1.22 (one.17) | one.41 (1.nineteen) | 1.36 (1.19) | one.49 (one.21) | 1.45 (1.eighteen) | i.37 (1.16) |
| Initial heart rhythm, northward (%) | |||||||
| Ventricular fibrillation | 3938 (16.3) | 700 (18.half-dozen) | 3238 (15.viii) | 956 (20.0) | 867 (17.7) | 734 (15.one) | 547 (12.nine) |
| Ventricular tachycardia | 1565 (half-dozen.five) | 297 (7.9) | 1268 (6.ii) | 378 (7.99) | 332 (6.76) | 288 (5.ix) | 196 (4.half-dozen) |
| Pulseless electrical action | 4785 (nineteen.8) | 729 (19.4) | 4056 (19.8) | 825 (17.4) | 944 (xix.2) | 977 (20.0) | 799 (18.viii) |
| Asystole | 7788 (32.2) | 1167 (31.0) | 6621 (32.4) | 1407 (29.7) | 1531 (31.two) | 1615 (33.i) | 1502 (35.3) |
| Missing | 6141 (25.4) | 867 (23.ane) | 5274 (25.8) | 1167 (24.7) | 1235 (25.ii) | 1264 (25.nine) | 1207 (29.4) |
| Cardiac aetiology, n (%) | |||||||
| Yeah | xi 514 (47.six) | 1775 (47.two) | 9739 (47.6) | 2427 (51.three) | 2481 (50.5) | 2400 (49.2) | 1993 (46.ix) |
| No | 2281 (ix.iv) | 359 (9.6) | 1922 (ix.4) | 350 (7.4) | 412 (8.4) | 407 (8.3) | 358 (viii.four) |
| Missing | 10 422 (43.0) | 1626 (43.2) | 8796 (43.0) | 1956 (41.three) | 2016 (41.ane) | 2071 (42.5) | 1900 (44.7) |
| Monitored, n (%) | |||||||
| Yes | 12 502 (51.6) | 2142 (57.0) | 10 360 (50.half dozen) | 2592 (54.8) | 2627 (53.v) | 2411 (49.4) | 2009 (47.iii) |
| No | 11 360 (46.nine) | 1555 (41.iv) | 9805 (47.9) | 2068 (43.vii) | 2222 (45.3) | 2396 (49.1) | 2194 (51.six) |
| Missing | 355 (1.5) | 63 (1.7) | 292 (1.43) | 73 (1.5) | 60 (i.22) | 71 (1.5) | 48 (1.13) |
| CPR delay, n (%) | |||||||
| Yes | 6118 (25.three) | 842 (22.4) | 5276 (25.8) | 1094 (23.one) | 1224 (24.9) | 1295 (26.6) | 1139 (26.8) |
| No | 14 303 (59.ane) | 2325 (61.eight) | xi 978 (58.6) | 2854 (60.3) | 2883 (58.7) | 2829 (58.0) | 2506 (59.0) |
| Missing | 3796 (15.seven) | 593 (15.eight) | 3203 (15.7) | 785 (16.6) | 802 (sixteen.iii) | 754 (fifteen.5) | 606 (14.iii) |
| CPR duration in minutes, hateful (SD) | sixteen.2 (fourteen.8) | 15.8 (15.one) | 16.3 (14.viii) | sixteen.6 (16.0) | 16.ii (14.2) | 15.9 (14.3) | 15.eight (14.four) |
| Missing, n (%) | 14 561 (60.1) | 2135 (56.8) | 12 426 (lx.vii) | 3169 (67.0) | 3194 (65.ane) | 3274 (67.one) | 2863 (67.4) |
| Survival afterwards CPR, n (%) | |||||||
| Yes | 12 503 (51.6) | 2128 (56.6) | 10 375 (50.7) | 2601 (55.0) | 2524 (51.four) | 2370 (48.half-dozen) | 1985 (46.7) |
| No | xi 714 (48.iv) | 1632 (43.four) | 10 082 (49.3) | 2132 (45.0) | 2385 (48.6) | 2508 (51.4) | 2266 (53.iii) |
| Treatment satisfaction, n (%) | |||||||
| Aye | 17 378 (71.8) | 2699 (71.8) | 14 679 (71.8) | 3358 (71.0) | 3541 (72.1) | 3546 (72.7) | 3067 (72.2) |
| No | 6839 (28.2) | 1061 (28.ii) | 5778 (28.ii) | 1375 (29.0) | 1368 (27.9) | 1332 (27.3) | 1184 (27.9) |
| Survival to belch with good neurological outcome, north (%) | |||||||
| Yes | 5597 (23.ane) | 1127 (30.0) | 4470 (21.9) | 1333 (28.2) | 1150 (23.four) | 991 (twenty.3) | 745 (17.5) |
| No | 16 839 (69.5) | 2362 (62.8) | 14 477 (70.8) | 3147 (66.5) | 3528 (71.9) | 3667 (75.ii) | 3314 (78.0) |
| Missing | 1781 (seven.iv) | 271 (7.2) | 1510 (7.four) | 253 (5.iv) | 231 (iv.7) | 220 (iv.5) | 192 (four.5) |
| thirty-day survival, northward (%) | |||||||
| Yeah | 7130 (29.4) | 1387 (36.9) | 5743 (28.0) | 1648 (34.eight) | 1450 (29.five) | 1283 (26.3) | 997 (23.v) |
| No | 17 087 (70.half-dozen) | 2373 (63.1) | 14 714 (71.ix) | 3085 (65.ii) | 3459 (lxx.5) | 3595 (73.7) | 3254 (76.6) |
A quartile separate was performed for SES income for sake of simplicity, although income was used every bit a continuous variable in the regression analyses. Cardiopulmonary resuscitation duration was longer than 90 min in 0.9% of the cases. These cases were recoded as missing, since such high numbers are unrealistic. The reason for the high fraction of missing values for CPR duration is mainly that this variable did non be in the register until 2013.
Table i
Descriptive statistics (unadjusted) for the total sample and different socioeconomic condition groups
| All | High SES (pedagogy) | Low SES (instruction) | SES income (4th quartile) | SES income (3rd quartile) | SES income (2d quartile) | SES income (1st quartile) | |
|---|---|---|---|---|---|---|---|
| (n = 24 217) | (n = 3760) | (northward = xx 457) | (n = 4733) | (n = 4909) | (northward = 4878) | (n = 4251) | |
| Age, mean (SD) | 73.6 (11.vi) | seventy.9 (11.8) | 74.1 (11.v) | 72.vii (10.7) | 74.6 (10.4) | 76.0 (10.1) | 77.vii (11.0) |
| Gender, n (%) | |||||||
| Female | 9287 (38.4) | 1227 (32.6) | 8060 (39.4) | 597 (12.vi) | 1062 (21.6) | 2434 (49.9) | 3081 (72.5) |
| Male | fourteen 930 (61.7) | 2533 (67.4) | 12 397 (threescore.six) | 4136 (87.four) | 3847 (78.4) | 2444 (50.i) | 1170 (27.v) |
| Ethnic background, n (%) | |||||||
| Nordic | 22 266 (91.9) | 3404 (90.5) | xviii 862 (92.ii) | 4532 (95.viii) | 4641 (94.5) | 4582 (93.iii) | 3764 (88.5) |
| Africa | 110 (0.v) | 19 (0.5) | 91 (0.4) | thirteen (0.8) | 9 (0.2) | 7 (0.ane) | 25 (0.half dozen) |
| Asia | 146 (0.6) | 42 (1.1) | 104 (0.5) | 17 (0.four) | 10 (0.2) | 17 (0.4) | 40 (0.94) |
| Eastern Europe | 393 (1.6) | 92 (2.iv) | 301 (ane.5) | lx (i.3) | 85 (1.73) | 69 (one.4) | 81 (1.9) |
| Middle East | 437 (1.8) | lxxx (2.1) | 357 (ane.eight) | xiv (0.3) | 24 (0.5) | 29 (0.6) | 148 (iii.5) |
| South Europe | 469 (i.9) | 46 (1.two) | 423 (ii.0) | 28 (0.vi) | 68 (1.four) | 89 (i.8) | 122 (2.nine) |
| Western Europe | 338 (ane.4) | 69 (1.8) | 269 (1.3) | 64 (1.four) | 67 (one.36) | 71 (1.5) | 56 (1.3) |
| Other | 58 (0.2) | 8 (0.2) | l (0.2) | 5 (0.1) | five (0.1) | fourteen (0.29) | fifteen (0.4) |
| Comorbidity index (0–7), mean (SD) | 1.38 (1.nineteen) | one.22 (1.17) | 1.41 (1.nineteen) | 1.36 (one.nineteen) | i.49 (1.21) | 1.45 (one.18) | i.37 (1.xvi) |
| Initial heart rhythm, n (%) | |||||||
| Ventricular fibrillation | 3938 (16.3) | 700 (18.6) | 3238 (15.8) | 956 (twenty.0) | 867 (17.7) | 734 (15.one) | 547 (12.9) |
| Ventricular tachycardia | 1565 (6.five) | 297 (7.nine) | 1268 (6.ii) | 378 (vii.99) | 332 (half-dozen.76) | 288 (v.9) | 196 (iv.6) |
| Pulseless electrical activity | 4785 (19.eight) | 729 (19.four) | 4056 (nineteen.8) | 825 (17.4) | 944 (19.two) | 977 (20.0) | 799 (xviii.8) |
| Asystole | 7788 (32.2) | 1167 (31.0) | 6621 (32.four) | 1407 (29.vii) | 1531 (31.2) | 1615 (33.1) | 1502 (35.3) |
| Missing | 6141 (25.4) | 867 (23.ane) | 5274 (25.viii) | 1167 (24.7) | 1235 (25.2) | 1264 (25.9) | 1207 (29.iv) |
| Cardiac aetiology, n (%) | |||||||
| Yes | eleven 514 (47.6) | 1775 (47.two) | 9739 (47.6) | 2427 (51.3) | 2481 (l.v) | 2400 (49.two) | 1993 (46.9) |
| No | 2281 (9.4) | 359 (9.6) | 1922 (nine.4) | 350 (7.iv) | 412 (eight.4) | 407 (8.3) | 358 (8.4) |
| Missing | ten 422 (43.0) | 1626 (43.2) | 8796 (43.0) | 1956 (41.3) | 2016 (41.1) | 2071 (42.5) | 1900 (44.7) |
| Monitored, northward (%) | |||||||
| Yes | 12 502 (51.6) | 2142 (57.0) | ten 360 (l.6) | 2592 (54.viii) | 2627 (53.v) | 2411 (49.4) | 2009 (47.3) |
| No | 11 360 (46.9) | 1555 (41.4) | 9805 (47.9) | 2068 (43.7) | 2222 (45.3) | 2396 (49.1) | 2194 (51.6) |
| Missing | 355 (1.five) | 63 (1.7) | 292 (ane.43) | 73 (1.v) | 60 (1.22) | 71 (ane.5) | 48 (1.13) |
| CPR delay, due north (%) | |||||||
| Yeah | 6118 (25.three) | 842 (22.4) | 5276 (25.viii) | 1094 (23.i) | 1224 (24.9) | 1295 (26.vi) | 1139 (26.viii) |
| No | 14 303 (59.1) | 2325 (61.8) | 11 978 (58.6) | 2854 (60.3) | 2883 (58.7) | 2829 (58.0) | 2506 (59.0) |
| Missing | 3796 (15.seven) | 593 (15.viii) | 3203 (15.7) | 785 (sixteen.vi) | 802 (sixteen.3) | 754 (15.five) | 606 (14.3) |
| CPR duration in minutes, mean (SD) | 16.2 (14.8) | 15.viii (fifteen.1) | 16.3 (14.8) | 16.6 (16.0) | 16.2 (14.2) | 15.9 (14.3) | 15.viii (14.4) |
| Missing, northward (%) | 14 561 (60.i) | 2135 (56.8) | 12 426 (60.7) | 3169 (67.0) | 3194 (65.1) | 3274 (67.one) | 2863 (67.iv) |
| Survival after CPR, n (%) | |||||||
| Yes | 12 503 (51.6) | 2128 (56.6) | 10 375 (fifty.7) | 2601 (55.0) | 2524 (51.4) | 2370 (48.vi) | 1985 (46.7) |
| No | 11 714 (48.4) | 1632 (43.four) | ten 082 (49.3) | 2132 (45.0) | 2385 (48.6) | 2508 (51.4) | 2266 (53.3) |
| Handling satisfaction, n (%) | |||||||
| Yes | 17 378 (71.eight) | 2699 (71.8) | xiv 679 (71.8) | 3358 (71.0) | 3541 (72.1) | 3546 (72.vii) | 3067 (72.2) |
| No | 6839 (28.2) | 1061 (28.2) | 5778 (28.ii) | 1375 (29.0) | 1368 (27.9) | 1332 (27.3) | 1184 (27.9) |
| Survival to discharge with good neurological event, n (%) | |||||||
| Yeah | 5597 (23.1) | 1127 (30.0) | 4470 (21.nine) | 1333 (28.two) | 1150 (23.4) | 991 (twenty.3) | 745 (17.v) |
| No | 16 839 (69.5) | 2362 (62.viii) | 14 477 (70.8) | 3147 (66.5) | 3528 (71.ix) | 3667 (75.two) | 3314 (78.0) |
| Missing | 1781 (7.4) | 271 (7.two) | 1510 (7.four) | 253 (v.4) | 231 (four.7) | 220 (four.v) | 192 (4.5) |
| 30-twenty-four hour period survival, n (%) | |||||||
| Yeah | 7130 (29.iv) | 1387 (36.9) | 5743 (28.0) | 1648 (34.8) | 1450 (29.five) | 1283 (26.iii) | 997 (23.5) |
| No | 17 087 (70.half-dozen) | 2373 (63.1) | 14 714 (71.ix) | 3085 (65.2) | 3459 (seventy.5) | 3595 (73.7) | 3254 (76.6) |
| All | Loftier SES (education) | Low SES (instruction) | SES income (4th quartile) | SES income (3rd quartile) | SES income (2d quartile) | SES income (1st quartile) | |
|---|---|---|---|---|---|---|---|
| (n = 24 217) | (n = 3760) | (n = twenty 457) | (north = 4733) | (n = 4909) | (northward = 4878) | (n = 4251) | |
| Age, mean (SD) | 73.6 (eleven.6) | 70.9 (11.8) | 74.1 (11.5) | 72.7 (10.vii) | 74.half-dozen (ten.4) | 76.0 (10.i) | 77.7 (11.0) |
| Gender, n (%) | |||||||
| Female | 9287 (38.4) | 1227 (32.6) | 8060 (39.4) | 597 (12.6) | 1062 (21.6) | 2434 (49.9) | 3081 (72.5) |
| Male person | 14 930 (61.7) | 2533 (67.4) | 12 397 (60.half-dozen) | 4136 (87.4) | 3847 (78.4) | 2444 (50.1) | 1170 (27.5) |
| Ethnic background, n (%) | |||||||
| Nordic | 22 266 (91.9) | 3404 (90.v) | 18 862 (92.2) | 4532 (95.viii) | 4641 (94.5) | 4582 (93.3) | 3764 (88.5) |
| Africa | 110 (0.5) | 19 (0.5) | 91 (0.iv) | 13 (0.eight) | 9 (0.two) | 7 (0.1) | 25 (0.6) |
| Asia | 146 (0.6) | 42 (1.one) | 104 (0.five) | 17 (0.4) | 10 (0.2) | 17 (0.four) | xl (0.94) |
| Eastern Europe | 393 (1.6) | 92 (2.4) | 301 (1.5) | sixty (i.3) | 85 (ane.73) | 69 (1.4) | 81 (one.nine) |
| Middle East | 437 (one.8) | eighty (2.i) | 357 (i.8) | 14 (0.3) | 24 (0.5) | 29 (0.6) | 148 (3.5) |
| South Europe | 469 (1.9) | 46 (1.2) | 423 (2.0) | 28 (0.6) | 68 (1.4) | 89 (1.viii) | 122 (2.9) |
| Western Europe | 338 (1.4) | 69 (1.8) | 269 (one.3) | 64 (one.4) | 67 (1.36) | 71 (ane.5) | 56 (ane.3) |
| Other | 58 (0.2) | 8 (0.2) | 50 (0.2) | 5 (0.1) | five (0.1) | xiv (0.29) | 15 (0.4) |
| Comorbidity index (0–7), mean (SD) | 1.38 (one.19) | i.22 (1.17) | i.41 (one.19) | 1.36 (ane.19) | ane.49 (1.21) | 1.45 (i.18) | one.37 (ane.16) |
| Initial middle rhythm, n (%) | |||||||
| Ventricular fibrillation | 3938 (16.3) | 700 (eighteen.six) | 3238 (15.viii) | 956 (20.0) | 867 (17.7) | 734 (15.1) | 547 (12.nine) |
| Ventricular tachycardia | 1565 (6.5) | 297 (7.9) | 1268 (six.two) | 378 (7.99) | 332 (6.76) | 288 (5.9) | 196 (four.6) |
| Pulseless electric activity | 4785 (nineteen.8) | 729 (19.4) | 4056 (19.viii) | 825 (17.4) | 944 (xix.ii) | 977 (20.0) | 799 (xviii.eight) |
| Asystole | 7788 (32.ii) | 1167 (31.0) | 6621 (32.4) | 1407 (29.seven) | 1531 (31.2) | 1615 (33.1) | 1502 (35.iii) |
| Missing | 6141 (25.4) | 867 (23.1) | 5274 (25.8) | 1167 (24.7) | 1235 (25.two) | 1264 (25.9) | 1207 (29.iv) |
| Cardiac aetiology, n (%) | |||||||
| Yes | 11 514 (47.6) | 1775 (47.2) | 9739 (47.6) | 2427 (51.iii) | 2481 (50.5) | 2400 (49.ii) | 1993 (46.ix) |
| No | 2281 (9.four) | 359 (9.6) | 1922 (ix.iv) | 350 (vii.iv) | 412 (8.4) | 407 (8.3) | 358 (viii.4) |
| Missing | 10 422 (43.0) | 1626 (43.2) | 8796 (43.0) | 1956 (41.3) | 2016 (41.1) | 2071 (42.v) | 1900 (44.7) |
| Monitored, north (%) | |||||||
| Yes | 12 502 (51.six) | 2142 (57.0) | 10 360 (fifty.half-dozen) | 2592 (54.8) | 2627 (53.5) | 2411 (49.4) | 2009 (47.iii) |
| No | 11 360 (46.ix) | 1555 (41.4) | 9805 (47.9) | 2068 (43.seven) | 2222 (45.3) | 2396 (49.i) | 2194 (51.half dozen) |
| Missing | 355 (1.5) | 63 (1.7) | 292 (1.43) | 73 (one.5) | threescore (ane.22) | 71 (1.5) | 48 (ane.13) |
| CPR delay, northward (%) | |||||||
| Yep | 6118 (25.three) | 842 (22.four) | 5276 (25.8) | 1094 (23.i) | 1224 (24.nine) | 1295 (26.half dozen) | 1139 (26.viii) |
| No | 14 303 (59.1) | 2325 (61.8) | 11 978 (58.6) | 2854 (60.3) | 2883 (58.vii) | 2829 (58.0) | 2506 (59.0) |
| Missing | 3796 (fifteen.7) | 593 (15.8) | 3203 (15.7) | 785 (16.half dozen) | 802 (16.3) | 754 (15.five) | 606 (xiv.three) |
| CPR duration in minutes, hateful (SD) | 16.two (14.viii) | xv.8 (fifteen.i) | sixteen.3 (fourteen.viii) | 16.six (16.0) | 16.two (xiv.2) | 15.9 (14.3) | 15.eight (14.4) |
| Missing, n (%) | 14 561 (lx.1) | 2135 (56.8) | 12 426 (threescore.7) | 3169 (67.0) | 3194 (65.1) | 3274 (67.i) | 2863 (67.4) |
| Survival after CPR, n (%) | |||||||
| Yes | 12 503 (51.half-dozen) | 2128 (56.six) | x 375 (50.seven) | 2601 (55.0) | 2524 (51.4) | 2370 (48.6) | 1985 (46.7) |
| No | 11 714 (48.iv) | 1632 (43.4) | 10 082 (49.3) | 2132 (45.0) | 2385 (48.half-dozen) | 2508 (51.4) | 2266 (53.3) |
| Treatment satisfaction, n (%) | |||||||
| Yeah | 17 378 (71.eight) | 2699 (71.8) | 14 679 (71.8) | 3358 (71.0) | 3541 (72.one) | 3546 (72.7) | 3067 (72.2) |
| No | 6839 (28.2) | 1061 (28.2) | 5778 (28.2) | 1375 (29.0) | 1368 (27.ix) | 1332 (27.three) | 1184 (27.9) |
| Survival to discharge with practiced neurological outcome, due north (%) | |||||||
| Yeah | 5597 (23.1) | 1127 (30.0) | 4470 (21.nine) | 1333 (28.2) | 1150 (23.4) | 991 (20.3) | 745 (17.five) |
| No | sixteen 839 (69.5) | 2362 (62.8) | fourteen 477 (lxx.8) | 3147 (66.5) | 3528 (71.9) | 3667 (75.2) | 3314 (78.0) |
| Missing | 1781 (vii.4) | 271 (vii.2) | 1510 (vii.four) | 253 (v.four) | 231 (4.7) | 220 (iv.5) | 192 (four.5) |
| 30-solar day survival, northward (%) | |||||||
| Yep | 7130 (29.4) | 1387 (36.9) | 5743 (28.0) | 1648 (34.8) | 1450 (29.5) | 1283 (26.3) | 997 (23.5) |
| No | 17 087 (70.6) | 2373 (63.one) | 14 714 (71.9) | 3085 (65.ii) | 3459 (70.5) | 3595 (73.vii) | 3254 (76.vi) |
A quartile split was performed for SES income for sake of simplicity, although income was used as a continuous variable in the regression analyses. Cardiopulmonary resuscitation duration was longer than 90 min in 0.9% of the cases. These cases were recoded as missing, since such high numbers are unrealistic. The reason for the high fraction of missing values for CPR elapsing is mainly that this variable did not exist in the register until 2013.
Primary analyses: socioeconomic status, in-hospital cardiac arrest treatment, and survival
The results of the regression analyses, controlling for historic period, gender, and ethnicity, comorbidity, heart rhythm, and aetiology, and including fixed furnishings for hospital and year, are reported in Table2.
Table 2
Association betwixt socioeconomic status and outcome variables (handling and survival)
| CPR delay (0/1) odds ratios (SE) | CPR duration (ln) B (SE) | Survival after CPR (0/i) odds ratios (SE) | Treatment satisfaction (0/1) odds ratios (SE) | Survival to belch with good neurological outcome (0/1) odds ratios (SE) | 30-day survival (0/one) odds ratios (SE) | |
|---|---|---|---|---|---|---|
| (ane) | (2) | (iii) | (iv) | (5) | (vi) | |
| Highly educated | 0.8907 * | −0.0597 * | i.0728 | i.0816 | i.2703 ** | 1.2065 ** |
| Standard error | (0.0408) | (0.0289) | (0.0432) | (0.0826) | (0.0611) | (0.0531) |
| 95% confidence interval | [0.8141, 0.9744] | [−0.1165, −.0030] | [0.9915, one.1608] | [0.9313, 1.2562] | [1.1560, 1.3959] | [1.1067, one.3152] |
| Pseudo R 2 (R 2 in col. 2) | 0.048 | 0.171 | 0.142 | 0.038 | 0.244 | 0.223 |
| C-statistic | 0.648 | n/a | 0.740 | 0.646 | 0.819 | 0.805 |
| N | 20 407 | 9444 | 24 030 | 18 953 | 22 155 | 24 030 |
| Income decile | 0.9842 * | −0.0023 | one.0202 ** | 1.0084 | 1.0627 ** | ane.0468 ** |
| Standard error | (0.0076) | (0.0055) | (0.0071) | (0.0129) | (0.0093) | (0.0084) |
| 95% conviction interval | [0.9694, 0.9991] | [−0.0130, 0.0084] | [1.0065, 1.0342] | [0.9833, 1.0340] | [1.0446, 1.0810] | [1.0306, 1.0634] |
| Pseudo R 2 (R 2 in col. ii) | 0.054 | 0.172 | 0.149 | 0.045 | 0.260 | 0.237 |
| C-statistic | 0.655 | north/a | 0.745 | 0.659 | 0.829 | 0.813 |
| Northward | xv 813 | 6139 | 18 666 | 14 796 | 17 472 | 18 659 |
| CPR delay (0/1) odds ratios (SE) | CPR duration (ln) B (SE) | Survival after CPR (0/ane) odds ratios (SE) | Handling satisfaction (0/1) odds ratios (SE) | Survival to discharge with good neurological outcome (0/1) odds ratios (SE) | thirty-day survival (0/1) odds ratios (SE) | |
|---|---|---|---|---|---|---|
| (1) | (ii) | (three) | (4) | (5) | (6) | |
| Highly educated | 0.8907 * | −0.0597 * | one.0728 | 1.0816 | ane.2703 ** | i.2065 ** |
| Standard error | (0.0408) | (0.0289) | (0.0432) | (0.0826) | (0.0611) | (0.0531) |
| 95% confidence interval | [0.8141, 0.9744] | [−0.1165, −.0030] | [0.9915, 1.1608] | [0.9313, 1.2562] | [1.1560, ane.3959] | [1.1067, 1.3152] |
| Pseudo R 2 (R ii in col. ii) | 0.048 | 0.171 | 0.142 | 0.038 | 0.244 | 0.223 |
| C-statistic | 0.648 | n/a | 0.740 | 0.646 | 0.819 | 0.805 |
| North | 20 407 | 9444 | 24 030 | 18 953 | 22 155 | 24 030 |
| Income decile | 0.9842 * | −0.0023 | i.0202 ** | i.0084 | one.0627 ** | one.0468 ** |
| Standard error | (0.0076) | (0.0055) | (0.0071) | (0.0129) | (0.0093) | (0.0084) |
| 95% confidence interval | [0.9694, 0.9991] | [−0.0130, 0.0084] | [i.0065, 1.0342] | [0.9833, 1.0340] | [i.0446, ane.0810] | [one.0306, i.0634] |
| Pseudo R ii (R two in col. ii) | 0.054 | 0.172 | 0.149 | 0.045 | 0.260 | 0.237 |
| C-statistic | 0.655 | north/a | 0.745 | 0.659 | 0.829 | 0.813 |
| Due north | xv 813 | 6139 | 18 666 | fourteen 796 | 17 472 | 18 659 |
Each cell/gauge is from a separate regression. All regressions used all observations of the full report population for which the dependent variable and SES proxy is non-missing. All regressions included fixed effects for infirmary and the year of the CA event and controlled for historic period, gender, ethnicity, comorbidity, heart rhythm, and aetiology. Standard errors in parentheses are robust. 95% confidence intervals are reported in brackets.
* Meaning at the 5% level.
** Significant at the ane% level.
Table 2
Association between socioeconomic condition and outcome variables (treatment and survival)
| CPR filibuster (0/i) odds ratios (SE) | CPR duration (ln) B (SE) | Survival afterward CPR (0/1) odds ratios (SE) | Treatment satisfaction (0/1) odds ratios (SE) | Survival to discharge with good neurological consequence (0/i) odds ratios (SE) | xxx-twenty-four hours survival (0/one) odds ratios (SE) | |
|---|---|---|---|---|---|---|
| (1) | (2) | (3) | (4) | (five) | (half dozen) | |
| Highly educated | 0.8907 * | −0.0597 * | 1.0728 | 1.0816 | i.2703 ** | ane.2065 ** |
| Standard error | (0.0408) | (0.0289) | (0.0432) | (0.0826) | (0.0611) | (0.0531) |
| 95% confidence interval | [0.8141, 0.9744] | [−0.1165, −.0030] | [0.9915, 1.1608] | [0.9313, 1.2562] | [ane.1560, ane.3959] | [1.1067, 1.3152] |
| Pseudo R 2 (R 2 in col. 2) | 0.048 | 0.171 | 0.142 | 0.038 | 0.244 | 0.223 |
| C-statistic | 0.648 | n/a | 0.740 | 0.646 | 0.819 | 0.805 |
| N | xx 407 | 9444 | 24 030 | xviii 953 | 22 155 | 24 030 |
| Income decile | 0.9842 * | −0.0023 | 1.0202 ** | ane.0084 | 1.0627 ** | 1.0468 ** |
| Standard mistake | (0.0076) | (0.0055) | (0.0071) | (0.0129) | (0.0093) | (0.0084) |
| 95% confidence interval | [0.9694, 0.9991] | [−0.0130, 0.0084] | [one.0065, 1.0342] | [0.9833, 1.0340] | [1.0446, 1.0810] | [1.0306, one.0634] |
| Pseudo R 2 (R two in col. 2) | 0.054 | 0.172 | 0.149 | 0.045 | 0.260 | 0.237 |
| C-statistic | 0.655 | n/a | 0.745 | 0.659 | 0.829 | 0.813 |
| North | 15 813 | 6139 | xviii 666 | 14 796 | 17 472 | xviii 659 |
| CPR delay (0/1) odds ratios (SE) | CPR duration (ln) B (SE) | Survival after CPR (0/1) odds ratios (SE) | Treatment satisfaction (0/i) odds ratios (SE) | Survival to discharge with good neurological event (0/1) odds ratios (SE) | xxx-day survival (0/1) odds ratios (SE) | |
|---|---|---|---|---|---|---|
| (1) | (2) | (3) | (4) | (5) | (six) | |
| Highly educated | 0.8907 * | −0.0597 * | 1.0728 | 1.0816 | 1.2703 ** | 1.2065 ** |
| Standard error | (0.0408) | (0.0289) | (0.0432) | (0.0826) | (0.0611) | (0.0531) |
| 95% confidence interval | [0.8141, 0.9744] | [−0.1165, −.0030] | [0.9915, 1.1608] | [0.9313, 1.2562] | [1.1560, 1.3959] | [1.1067, 1.3152] |
| Pseudo R two (R 2 in col. 2) | 0.048 | 0.171 | 0.142 | 0.038 | 0.244 | 0.223 |
| C-statistic | 0.648 | northward/a | 0.740 | 0.646 | 0.819 | 0.805 |
| N | 20 407 | 9444 | 24 030 | 18 953 | 22 155 | 24 030 |
| Income decile | 0.9842 * | −0.0023 | 1.0202 ** | 1.0084 | 1.0627 ** | 1.0468 ** |
| Standard error | (0.0076) | (0.0055) | (0.0071) | (0.0129) | (0.0093) | (0.0084) |
| 95% confidence interval | [0.9694, 0.9991] | [−0.0130, 0.0084] | [i.0065, ane.0342] | [0.9833, 1.0340] | [1.0446, ane.0810] | [1.0306, 1.0634] |
| Pseudo R 2 (R ii in col. 2) | 0.054 | 0.172 | 0.149 | 0.045 | 0.260 | 0.237 |
| C-statistic | 0.655 | n/a | 0.745 | 0.659 | 0.829 | 0.813 |
| Northward | 15 813 | 6139 | eighteen 666 | 14 796 | 17 472 | 18 659 |
Each prison cell/estimate is from a split regression. All regressions used all observations of the full written report population for which the dependent variable and SES proxy is non-missing. All regressions included stock-still effects for infirmary and the year of the CA event and controlled for age, gender, ethnicity, comorbidity, heart rhythm, and aetiology. Standard errors in parentheses are robust. 95% confidence intervals are reported in brackets.
* Pregnant at the 5% level.
** Meaning at the i% level.
Cardiopulmonary resuscitation delay
Patients with higher SES were less probable to receive delayed CPR. For highly educated patients, the likelihood of a delay was significantly lower than for patients with low education (OR = 0.89, P = 0.012). For income, being ane decile (10 pct points) higher up in the income distribution was significantly associated with a lower likelihood of a delay (OR = 0.98, P = 0.038).
Cardiopulmonary resuscitation elapsing
Highly educated patients received significantly shorter CPR duration (B = −0.06, P = 0.039). For income, the association was not statistically meaning (B = −0.00, P = 0.674).
Survival after cardiopulmonary resuscitation
Education was non statistically significant associated with immediate survival (OR = i.07, P = 0.081). However, higher income was significantly associated with a college likelihood of firsthand survival (OR = one.02, P = 0.004).
Treatment satisfaction
Neither education nor income was significantly associated with handling satisfaction (OR = ane.08, P = 0.304 vs. OR = 1.01, P = 0.516).
Survival to belch with good neurological issue
High didactics was significantly associated with a higher likelihood to be live at discharge with good neurological outcome compared with low education (OR = 1.27, P < 0.001). Income was also significantly associated with survival to discharge with practiced neurological outcome (OR = 1.06, P < 0.001).
xxx-day survival
Highly educated patients were significantly more likely to be alive after thirty days compared with patients with depression educational activity (OR = 1.21, P < 0.001). Higher income was too significantly associated with greater 30-day survival (OR = 1.05, P < 0.001).
Secondary analyses: socioeconomic status and middle rhythm monitoring
The results revealed that highly educated patients (OR = ane.16, P < 0.001) and patients with higher income (OR = 1.02, P = 0.001) were significantly more probable to have their eye rhythm monitored prior to the onset of the CA, even with stock-still effects for hospital and year in the regression and when controlling for demographic characteristics (age, gender, ethnicity) and comorbidity.
In addition to being associated with SES, center rhythm monitoring was significantly associated with less CPR filibuster (rho = −0.213), shorter CPR duration (rho = −0.163), and increased survival immediately later on CPR (rho = 0.238), survival to discharge with good neurological status (rho = 0.283), and survival to xxx days (rho = 0.285). Consequently, we examined the possibility that higher incidence of heart rhythm monitoring among patients with high SES would partly explain the SES differences in CA outcomes in Tabular arraytwo. To this end, the fixed-effects regression analyses in Tabular array2 were repeated, but now with heart rhythm monitoring equally an boosted control variable (Table3). Socioeconomic status was no longer a significant predictor of CPR delay (Education, P = 0.050; Income, P = 0.074). The association betwixt SES and CPR duration was also no longer significant (Instruction, P = 0.067; Income, P = 0.769). Finally, the association between SES and our survival outcomes (survival later on CPR, to discharge with good neurological outcome, and to 30 days) remained significant. In sum, middle rhythm monitoring may partially explicate the human relationship between SES and CPR delay.
Table 3
Association between socioeconomic status and outcome variables (handling and survival), adding aligning for middle rhythm monitoring
| CPR delay (0/1) odds ratios (SE) | CPR duration (ln) B (SE) | Survival after CPR (0/ane) odds ratios (SE) | Treatment Satisfaction (0/1) odds ratios (SE) | Survival to belch with good neurological outcome (0/1) odds ratios (SE) | Survival 30 days (0/one) odds ratios (SE) | |
|---|---|---|---|---|---|---|
| (1) | (2) | (3) | (4) | (5) | (6) | |
| Highly educated | 0.9122 | −0.0524 | ane.0562 | one.0649 | 1.2548 ** | 1.1911 ** |
| Standard error | (0.0427) | (0.0286) | (0.0430) | (0.0815) | (0.0612) | (0.0533) |
| 95% conviction interval | [0.8322, 0.9999] | [−0.1083, 0.0036] | [0.9752, one.1439] | [0.9165, i.2373] | [i.1404, i.3808] | [ane.0911, 1.3002] |
| Pseudo R 2 (R 2 in col. ii) | 0.074 | 0.189 | 0.156 | 0.047 | 0.262 | 0.243 |
| C-statistic | 0.684 | north/a | 0.754 | 0.663 | 0.831 | 0.818 |
| N | 20 407 | 9444 | 24 030 | 18 953 | 22 155 | 24 030 |
| Income decile | 0.9861 | −0.0016 | i.0186 ** | 1.0067 | i.0610 ** | 1.0448 ** |
| Standard error | (0.0077) | (0.0054) | (0.0071) | (0.0129) | (0.0094) | (0.0085) |
| 95% confidence interval | [0.9711, 1.0014] | [−0.0122, 0.0090] | [1.0047, 1.0326] | [0.9818, ane.0322] | [one.0427, 1.0796] | [ane.0283, 1.0615] |
| Pseudo R ii (R two in col. two) | 0.078 | 0.187 | 0.163 | 0.055 | 0.276 | 0.256 |
| C-statistic | 0.688 | n/a | 0.759 | 0.673 | 0.839 | 0.826 |
| N | 15 813 | 6139 | 18 666 | 14 796 | 17 472 | eighteen 659 |
| CPR filibuster (0/1) odds ratios (SE) | CPR duration (ln) B (SE) | Survival after CPR (0/1) odds ratios (SE) | Treatment Satisfaction (0/1) odds ratios (SE) | Survival to belch with practiced neurological outcome (0/1) odds ratios (SE) | Survival thirty days (0/1) odds ratios (SE) | |
|---|---|---|---|---|---|---|
| (one) | (two) | (3) | (iv) | (v) | (6) | |
| Highly educated | 0.9122 | −0.0524 | 1.0562 | one.0649 | one.2548 ** | one.1911 ** |
| Standard error | (0.0427) | (0.0286) | (0.0430) | (0.0815) | (0.0612) | (0.0533) |
| 95% conviction interval | [0.8322, 0.9999] | [−0.1083, 0.0036] | [0.9752, 1.1439] | [0.9165, 1.2373] | [i.1404, 1.3808] | [1.0911, 1.3002] |
| Pseudo R 2 (R two in col. 2) | 0.074 | 0.189 | 0.156 | 0.047 | 0.262 | 0.243 |
| C-statistic | 0.684 | n/a | 0.754 | 0.663 | 0.831 | 0.818 |
| Due north | 20 407 | 9444 | 24 030 | 18 953 | 22 155 | 24 030 |
| Income decile | 0.9861 | −0.0016 | ane.0186 ** | i.0067 | 1.0610 ** | 1.0448 ** |
| Standard error | (0.0077) | (0.0054) | (0.0071) | (0.0129) | (0.0094) | (0.0085) |
| 95% confidence interval | [0.9711, 1.0014] | [−0.0122, 0.0090] | [one.0047, 1.0326] | [0.9818, 1.0322] | [1.0427, 1.0796] | [one.0283, 1.0615] |
| Pseudo R ii (R 2 in col. 2) | 0.078 | 0.187 | 0.163 | 0.055 | 0.276 | 0.256 |
| C-statistic | 0.688 | n/a | 0.759 | 0.673 | 0.839 | 0.826 |
| N | 15 813 | 6139 | eighteen 666 | 14 796 | 17 472 | xviii 659 |
Regressions mirror those reported in Table2 simply add adjustment for center rhythm monitoring.
** Meaning at the i% level.
Tabular array iii
Association between socioeconomic status and consequence variables (treatment and survival), adding adjustment for middle rhythm monitoring
| CPR delay (0/1) odds ratios (SE) | CPR duration (ln) B (SE) | Survival after CPR (0/1) odds ratios (SE) | Treatment Satisfaction (0/1) odds ratios (SE) | Survival to discharge with good neurological outcome (0/1) odds ratios (SE) | Survival thirty days (0/1) odds ratios (SE) | |
|---|---|---|---|---|---|---|
| (i) | (2) | (3) | (4) | (five) | (half dozen) | |
| Highly educated | 0.9122 | −0.0524 | 1.0562 | ane.0649 | 1.2548 ** | 1.1911 ** |
| Standard error | (0.0427) | (0.0286) | (0.0430) | (0.0815) | (0.0612) | (0.0533) |
| 95% conviction interval | [0.8322, 0.9999] | [−0.1083, 0.0036] | [0.9752, i.1439] | [0.9165, ane.2373] | [one.1404, 1.3808] | [ane.0911, 1.3002] |
| Pseudo R ii (R two in col. ii) | 0.074 | 0.189 | 0.156 | 0.047 | 0.262 | 0.243 |
| C-statistic | 0.684 | n/a | 0.754 | 0.663 | 0.831 | 0.818 |
| N | 20 407 | 9444 | 24 030 | 18 953 | 22 155 | 24 030 |
| Income decile | 0.9861 | −0.0016 | 1.0186 ** | ane.0067 | 1.0610 ** | 1.0448 ** |
| Standard mistake | (0.0077) | (0.0054) | (0.0071) | (0.0129) | (0.0094) | (0.0085) |
| 95% confidence interval | [0.9711, one.0014] | [−0.0122, 0.0090] | [1.0047, ane.0326] | [0.9818, i.0322] | [ane.0427, ane.0796] | [i.0283, one.0615] |
| Pseudo R 2 (R two in col. two) | 0.078 | 0.187 | 0.163 | 0.055 | 0.276 | 0.256 |
| C-statistic | 0.688 | n/a | 0.759 | 0.673 | 0.839 | 0.826 |
| N | 15 813 | 6139 | 18 666 | 14 796 | 17 472 | eighteen 659 |
| CPR delay (0/1) odds ratios (SE) | CPR duration (ln) B (SE) | Survival after CPR (0/1) odds ratios (SE) | Treatment Satisfaction (0/1) odds ratios (SE) | Survival to discharge with practiced neurological outcome (0/i) odds ratios (SE) | Survival 30 days (0/1) odds ratios (SE) | |
|---|---|---|---|---|---|---|
| (1) | (2) | (three) | (iv) | (5) | (half-dozen) | |
| Highly educated | 0.9122 | −0.0524 | 1.0562 | 1.0649 | one.2548 ** | i.1911 ** |
| Standard fault | (0.0427) | (0.0286) | (0.0430) | (0.0815) | (0.0612) | (0.0533) |
| 95% confidence interval | [0.8322, 0.9999] | [−0.1083, 0.0036] | [0.9752, 1.1439] | [0.9165, ane.2373] | [1.1404, ane.3808] | [1.0911, one.3002] |
| Pseudo R 2 (R ii in col. 2) | 0.074 | 0.189 | 0.156 | 0.047 | 0.262 | 0.243 |
| C-statistic | 0.684 | north/a | 0.754 | 0.663 | 0.831 | 0.818 |
| N | twenty 407 | 9444 | 24 030 | 18 953 | 22 155 | 24 030 |
| Income decile | 0.9861 | −0.0016 | 1.0186 ** | 1.0067 | 1.0610 ** | i.0448 ** |
| Standard mistake | (0.0077) | (0.0054) | (0.0071) | (0.0129) | (0.0094) | (0.0085) |
| 95% confidence interval | [0.9711, one.0014] | [−0.0122, 0.0090] | [1.0047, 1.0326] | [0.9818, ane.0322] | [i.0427, i.0796] | [1.0283, 1.0615] |
| Pseudo R two (R ii in col. 2) | 0.078 | 0.187 | 0.163 | 0.055 | 0.276 | 0.256 |
| C-statistic | 0.688 | northward/a | 0.759 | 0.673 | 0.839 | 0.826 |
| Northward | 15 813 | 6139 | 18 666 | 14 796 | 17 472 | eighteen 659 |
Regressions mirror those reported in Tabular array2 just add adjustment for heart rhythm monitoring.
** Pregnant at the 1% level.
The role of infirmary type
Considering heart rhythm monitoring facilities is a clear indicator of infirmary capacity, the possibility that SES differences in centre rhythm monitoring emerge in certain hospital types were examined. In the following analyses, the hospitals were now categorized into iii dissimilar types based on the infirmary classification system currently employed in Sweden to indicate hospital capacity (due east.one thousand. range of intendance and patient capacity in emergency departments). In descending club of capacity, the three hospital types were: regional, county, and district hospitals.
The previous fixed-effect regressions with heart rhythm monitoring every bit the dependent variable were repeated, merely with the SES variable replaced by the iii interaction terms between SES and infirmary type. Annotation that the regressions notwithstanding controlled for private hospital (fixed effect; 73 dummies). F-tests of equal coefficients of the three interaction terms did non decline that the associations between instruction and center rhythm monitoring, and income and heart rhythm monitoring, were equal beyond hospital types (Educational activity, P = 0.778; and Income, P = 0.584). Thus, SES differences in heart rhythm monitoring seem to be independent of hospital type.
In addition to heart rhythm monitoring facilities, access to other resources could also vary across infirmary types. Therefore, the possibility of heterogeneity in the association betwixt SES and the other studied outcome variables across hospital types was examined. All regressions in Tabular arraytwo were repeated, but now with the SES variable replaced past the SES by hospital type interaction terms (notwithstanding controlling for individual hospital equally above). For each regression, an F-test of equal SES coefficients across hospital types could non decline that the association between SES and the outcome are equal across infirmary types. Thus, the SES differences in outcomes reported in Table2 appear contained of hospital type.
Discussion
This study demonstrates that college SES is associated with a significantly lower likelihood of receiving delayed CPR when suffering IHCA, besides as a subsequent higher likelihood of being alive immediately later on CPR. Furthermore, patients with high SES are more likely to survive to belch with proficient neurological upshot, and to exist live 30 days after IHCA. We likewise find that patients with loftier SES are more likely to accept their heart rhythm monitored prior to the IHCA, despite having better health (less comorbidity). This more frequent heart rhythm monitoring seems to partially explain the less delayed CPR for patients with high SES.
The finding that SES differences remain after controlling for major demographic, clinical, and contextual factors suggests the presence of handling bias/discrimination. Such bias, where patients are treated differently due to their SES, may stalk from prejudiced attitudes among hospital staff. If so, this would exist consistent with a body of inquiry showing that low SES groups (e.g. poor and homeless people) face some of the most severe prejudices in society. xx They tend to be disrespected and elicit negative emotional reactions (e.yard. contempt and cloy). 20 At the farthermost, inquiry on dehumanization suggests that these groups are sometimes perceived every bit possessing fewer human attributes compared with more respected groups in society. 21
Reassuringly, however, most of the uncovered associations between patient SES and the studied outcomes are small, meaning that a large majority of IHCA patients with low SES is not subjected to disparate treatment. However, because human lives are at stake, an SES-related survival odds difference of ∼21% (our effect size for 30-24-hour interval survival) should non exist ignored. This would mean that 818 of the 14 714 IHCA deaths of the lowly educated patients reported in the SRCR (2005–xviii) could be attributed to instruction.
It should exist noted that patients with high SES have shorter CPR duration. This is non surprising considering that the resuscitation attempt seems to be started earlier for these patients. Moreover, patients with high SES are more likely to be successfully resuscitated which may too explain a somewhat shorter CPR duration. Nonetheless, the human relationship between SES and CPR duration becomes not-significant when center rhythm monitoring is controlled for. It is nevertheless reassuring to notice that resuscitation does not appear to be terminated more chop-chop amidst patients with low SES once CPR has been started, although in that location seems to be a slight delay in the determination to start resuscitation.
Treatment satisfaction was not significantly related to patient SES in whatsoever of our analyses. This is interesting given that patients with low SES are more than likely to receive delayed CPR, and less likely to survive the IHCA. It is possible that the medical staff practise not realize that they provide different treatment due to patient SES, and that survival rates are lower among patients with depression SES. Another interpretation could be that the medical staff has a lower threshold for what constitutes satisfactory treatment when the patients have low SES. Alternatively, they may exist reluctant to report less treatment satisfaction later having treated patients with low SES in order to avoid appearing prejudiced.
Clinical implications
The SES differences in treatment and survival need farther attention. It seems particularly important to address why patients with depression SES have their heart rhythm monitored less frequently. It is troublesome that this group of patients is prioritized less when it comes to rubber treatment despite having a seemingly greater need for this due to poorer initial wellness. The statement that they are as well ill to receive such treatment appears invalid because the studied sample only contains patients who received CPR.
To combat these seemingly unjustified SES differences and to prevent future ones from occurring, hospitals may consider enrolling their CA teams in equality grooming programmes. The focus of such programmes could be on awareness training where teams become mindful of their ain bias and larn how SES-related prejudice might interpret into discriminatory treatment.
Limitations
The SRCR only contains patients on whom resuscitation was attempted. The current written report likely constitutes a conservative test of discrimination because information technology probed for discrimination in a sample where the commencement decision to care for had already been made. Information technology is possible that most discrimination occurs earlier, during the determination-making process itself. Once the medical staff have decided to offset CPR, they may exist adamant to continue.
It is also possible that the observed SES disparities are underestimated due to the statistical adjustment for heart rhythm and aetiology. Although hearth rhythm and aetiology by and large should reflect wellness condition that is fixed at the time of the CA, these variables are not strictly predetermined. Because heart rhythm is assessed afterward the CA warning, and aetiology is determined mail service-CA, they could partly be influenced past events happening after the onset of the CA. For example, the greater CPR delay observed for patients with low SES could result in a less beneficial (not-shockable) heart rhythm. Decision-making for heart rhythm may therefore remove some of the variance attributed to SES. 22
Nosotros did not specifically arrange for the care unit in which the CA occurred. However, data nearly whether the patient's centre rhythm was monitored at the time of the CA could be seen every bit a 'proxy' for care unit, since most patients in the intensive intendance unit of measurement are heart rhythm monitored, whereas the opposite holds true for general wards.
The electric current research was conducted in Sweden. The results may not generalize to other countries. Withal, since Sweden is regarded to be at the forefront of equality, 23 the observed grouping differences may be larger in other countries.
Compared with previous research, the electric current report controlled for a big number of potential confounders. Nevertheless, our findings are correlational, not causal. Information technology is possible that some unobserved gene (due east.yard. smoking habits or another lifestyle cistron) explains the observed SES differences. Relatedly, although we were able to adjust for major clinical factors, the existence of more extensive comorbidity data would have allowed for even more rigorous control over potential medical confounders.
The SES income proxy had missing values in 22% of the cases (null-reported income from piece of work and zero retirement benefits in Statistics Sweden'south registers). We cannot dominion out that these patients are a selective group and that the results would exist afflicted if nosotros had data for these patients.
Conclusion
There are clear SES differences in IHCA treatment and survival, even when decision-making for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to bigotry when suffering IHCA.
Funding
This inquiry was supported by the Swedish Research Council for Health, Working Life and Welfare (Forte) (grant number 2018-00256 to J.A.).
Report blessing
This inquiry has been conducted co-ordinate to the principles of Helsinki and was canonical by the Regional Upstanding Review Board in Linköping, Sweden (No. 2017/293-31).
Data availability
Data cannot be shared for upstanding/privacy reasons.
Conflict of interest: none alleged.
References
1
Wong
CX
, Brown A Lau DH Chugh SS Albert CM Kalman JM Sanders P.
Epidemiology of sudden cardiac death: global and regional perspectives
.
Center Lung Circ
2019
;
28
:
6
–
fourteen
.
2
Ahn
KO
, Shin SD Hwang SS Oh J Kawachi I Kim YT Kong KA Hong SO.
Clan between deprivation condition at customs level and outcomes from out-of-infirmary cardiac arrest: a nationwide observational study
.
Resuscitation
2011
;
82
:
270
–
276
.
3
Clarke
So
, Schellenbaum GD Rea TD.
Socioeconomic status and survival from out‐of‐hospital cardiac arrest
.
Acad Emerg Med
2005
;
12
:
941
–
947
.
4
Hallstrom
A
, Boutin P Cobb 50 Johnson Due east.
Socioeconomic status and prediction of ventricular fibrillation survival
.
Am J Public Health
1993
;
83
:
245
–
248
.
5
Lee
SY
, Song KJ Shin SD Ro YS Hong KJ Kim YT Hong And so Park JH Lee SC.
A disparity in outcomes of out-of-hospital cardiac arrest by customs socioeconomic status: a ten-year observational study
.
Resuscitation
2018
;
126
:
130
–
136
.
six
Vaillancourt
C
, Lui A De Maio VJ Wells GA Stiell IG.
Socioeconomic condition influences bystander CPR and survival rate for out-of-hospital cardiac arrest victims
.
Resuscitation
2008
;
79
:
417
–
423
.
7
Wells
DM
, White LL Fahrenbruch CE Rea TD.
Socioeconomic status and survival from ventricular fibrillation out-of-hospital cardiac abort
.
Ann Epidemiol
2016
;
26
:
418
–
423
.
8
Jonsson
Chiliad
, Härkönen J Ljungman P Rawshani A Nordberg P Svensson L Herlitz J Hollenberg J.
Survival after out-of-hospital cardiac arrest is associated with surface area-level socioeconomic condition
.
Eye
2019
;
105
:
632
–
638
.
9
Galea
South
, Blaney Southward Nandi A Silverman R Vlahov D Foltin G Kusick M Tunik Chiliad Richmond Northward.
Explaining racial disparities in incidence of and survival from out-of-hospital cardiac abort
.
Am J Epidemiol
2007
;
166
:
534
–
543
.
10
Sayegh
AJ
, Swor R Chu KH Jackson R Gitlin J Domeier RM Basse Eastward Smith D Fales Westward.
Does race or socioeconomic status predict agin outcome afterwards out of hospital cardiac abort: a multi-eye study
.
Resuscitation
1999
;
xl
:
141
–
146
.
11
Sondergaard
K B
, Wissenberg M Gerds T A Rajan S Karlsson L Kragholm Thousand Pape M Lippert F K Gislason G H Folke F Torp-Pedersen C Hansen Due south M.
Bystander cardiopulmonary resuscitation and long-term outcomes in out-of-hospital cardiac arrest according to location of arrest
.
European Heart Journal
2019
;
xl
:
309
–
318
.
12
Stankovic
Due north
, Høybye M Lind PC Holmberg M Andersen LW.
Socioeconomic status and in-infirmary cardiac arrest: a systematic review
.
Resuscitation Plus
2020
;
3
:
100016
.
13
Pamuk
Eastward
, Makuc D Heck K Reuben C Lochner Grand.
Health, U.s.a.: Socioeconomic Status and Wellness Chartbook
.
Hyattsville, Doctor
:
National Eye for Health Statistics
;
1998
.
fourteen
Chan
PS
, Nichol G Krumholz HM Spertus JA Jones PG Peterson ED Rathore SS Nallamothu BK.
Racial differences in survival after in-hospital cardiac arrest
.
JAMA
2009
;
302
:
1195
–
1201
.
fifteen
Chen
LM
, Nallamothu BK Spertus JA Tang Y Chan PS
Racial differences in long-term outcomes amongst older survivors of in-infirmary cardiac abort
.
Circulation
2018
;
138
:
1643
–
1650
.
16
Shah
KS
, Shah AS Bhopal R.
Systematic review and meta-analysis of out-of-hospital cardiac arrest and race or ethnicity: black The states populations fare worse
.
Eur J Prev Cardiol
2014
;
21
:
619
–
638
.
17
Sandroni
C
, Nolan J Cavallaro F Antonelli G.
In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival
.
Intensive Intendance Med
2007
;
33
:
237
–
245
.
18
American Psychological Association, APA Task Force on Socioeconomic Status.
Study of the APA Job Forcefulness on Socioeconomic Condition
.
Washington, DC
:
American Psychological Association
;
2007
.
19
StataCorp.
Stata Statistical Software: Release 16
.
College Station, TX
:
StataCorp LLC
;
2019
.
20
Fiske
ST
, Cuddy AJC Glick P.
Universal dimensions of social cognition: warmth and competence
.
Trends Cogn Sci
2007
;
xi
:
77
–
83
.
21
Harris
LT
, Fiske ST.
Dehumanizing the lowest of the depression: neuro-imaging responses to extreme outgroups
.
Psychol Sci
2006
;
17
:
847
–
853
.
22
Angrist
JD
, Pischke JS
Mostly harmless econometrics: an empiricist's companion
.
Princeton, NJ
:
Princeton Academy Press
;
2009
.
© The Author(s) 2020. Published past Oxford University Press on behalf of the European Society of Cardiology.
This is an Open up Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits not-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
© The Writer(s) 2020. Published by Oxford University Printing on behalf of the European Society of Cardiology.
Do People With Low Ses Background Receive The Same Medical Care As Those Who Are High Ses,
Source: https://academic.oup.com/eurheartj/article/42/8/861/6042374
Posted by: tyrephost1941.blogspot.com
0 Response to "Do People With Low Ses Background Receive The Same Medical Care As Those Who Are High Ses"
Post a Comment