Socioeconomic status linked to survival rate after in-hospital cardiac arrest

The researchers have analysed 24,217 cases of sudden cardiac arrest that occurred at Swedish hospitals between 2005 and 2018.

The researchers also got access to socioeconomic data about the patients and used highest education level and annual income as indicators of socioeconomic status (SES). In the analyses, adjustments were made for a number of control variables like age, gender, ethnicity, various medical background factors (including the cause of the cardiac arrest) and the hospital where the cardiac arrest occurred.

“Earlier research has shown that people with lower SES are less likely to survive a sudden out-of-hospital cardiac arrest than patients with a higher SES. However, up until now it has not been established whether this is the case also for in-hospital cardiac arrest, for which we expect the same standard of care regardless of background”, says professor Jens Agerströn, who has studied discrimination on the labour market for many years.

This is the first European study focusing on this and the first study that indicates that SES, rather than other factors, has an impact on care measures and survival rate.

A remarkable finding was that patients with higher SES also received more preventive measures in the form of ECG monitoring before the cardiac arrest occurred, despite the fact that their health condition was better.

Jens Agerström means that this could imply that patients with a lower SES are discriminated against when decisions are made on what care measures are to be taken.

However, reassuringly, the results show that in a clear majority of the cases, patients are treated equally regardless of socioeconomic status. But, regardless of the extent, it is important to counteract discrimination as this concerns a matter of human lives”, Jens Agerström adds.

The differences in survival rates are by no means trivial. Out of roughly 1,000 patients with lower SES, 280 patients are alive 30 days after the cardiac arrest. For patients with higher SES, that number is 320.

Jens Agerström points out the importance of both increased awareness and early education measures to avoid discriminatory treatment.

“Research shows that people with lower SES encounter prejudiced attitudes in many societies and cultures, which is why we mean that it is fully possible that prejudices exist also within healthcare. These prejudices may be unconscious”, Agerström explains.

Jens Agerström has dedicated the last five years to this research project, which was a natural step for him after having studied discrimination on the labor market for many years.

“Considerably fewer studies have been conducted on the occurrence of discrimination in the health care system. My own medical visits also played a role here, as I got the impression that the staff did a more thorough job after having asked me about my profession”, Agerström concludes.

More information

• The study: Agerström, J., Carlsson, M., Bremer, A., Herlitz, J., Israelsson, J., & Årestedt, K. Discriminatory cardiac arrest care? Patients with low socioeconomic status receive delayed cardiopulmonary resuscitation and are less likely to survive an in-hospital cardiac arrest, European Heart Journal – Ehaa954.
• The study is part of the work in the Equal health care research project.
• Read the press release from the European Society of Cardiology.
• The European Heart Journal is the flagship journal of the European Society of Cardiology. It is published on behalf of the ESC by Oxford Journals, a division of Oxford University Press.