People living in Hampshire’s most deprived areas may be less likely to survive a cardiac arrest, according to new research.
The study was led by the University of Southampton. It analysed ambulance data from more than 4,000 out-of-hospital cardiac arrests (OHCAs) in the region.
The results showed that people living in deprived communities were less likely to survive for 30 days after an OHCA. They have been published in a special edition of Resuscitation Plus, focusing on inequality in cardiac arrest.
Researchers say the findings highlight an important issue. This could have implications for public health policy.
The research was carried out in collaboration with University Hospital Southampton (UHS), South Central Ambulance Service (SCAS), Hampshire and Isle of Wight Air Ambulance (HIOWAA) and the National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre (BRC).
Health inequalities
The ambulance service in England attends more than 84,000 OHCAs a year.
Survival rates are low, with only around one in ten people surviving and leaving hospital. CPR and defibrillation can significantly improve the chance of survival.
Health inequality is an important issue across healthcare. There is growing international evidence of such inequalities in resuscitation following OHCA.
Previous research has shown that OHCAs occur most frequently in high density areas. They disproportionately affect people from non-white backgrounds, technical workers and those with lower levels of education.
Studies have also found that bystander CPR is less common in deprived communities, which may further reduce survival rates.
Dr James Plumb, Head of Research at HIOWAA and a Consultant Anaesthetist at UHS, co-led the research. He is also part of the NIHR Southampton BRC. Dr Plumb said:
“Across all areas of healthcare, we see differences in how patients do based on their background.
“We fairly consistently see that our most deprived communities experience worse health outcomes. This hasn’t been studied as widely in OHCA as some other areas of medicine.
“We wanted to understand how deprivation affects survival in after OHCA in Hampshire, with the hope that we could then move towards programmes to help reverse any inequality.”
Do inequalities affect survival?
The researchers examined 30-day survival rates after OHCA between 2019 and 2023. They used ambulance service data. This was linked with national measurements of deprivation based on patients’ home postcodes.
Patients were excluded from the analysis if their cardiac arrest was caused by trauma.
Of the 4,184 patients included in the study, 437 (10%) survived for at least 30 days.
The research team adjusted for factors such as age, sex, the initial heart rhythm and ambulance response times.
Their analysis revealed a significant association between neighbourhood deprivation and survival.
Dr Sandy (Alexander) Jackson drove the statistical analysis. He is a NIHR Doctoral Fellow at the University of Southampton and part of the NIHR Southampton BRC.
“Once we accounted for other factors that might affect survival it became clear that deprivation does appear to be related to reduced survival,” Dr Jackson explained. “This is similar to findings in Scotland, and we suspect it may be true across other parts of the UK.
“We hope this work will prompt more widespread study of the issue, including how we might improve outcomes for our most deprived communities.”
Role of age
Survivors were, on average, significantly younger than those who died. Those who survived had an average age of 62, while the average age of those who died was 71.
The data also showed that OHCA patients in deprived areas tended to be younger than those in less deprived areas.
Researchers suggest that while younger age is linked to better survival outcomes, it may mask overall health status.
Peter Owen, a Specialist Paramedic at HIOWAA, co-authored the research. He added:
“Before we accounted for other factors, we didn’t see a big difference in survival between different levels of deprivation. But once we took age into account it became clear that the outcomes, for similarly aged patients, were worse in deprived populations. It’s hard to be certain about what is driving this.
“It’s possible that these patients have more health problems than similarly aged patients from less deprived areas, and that is supported by research from other areas of healthcare.”
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