Association between location of out-of-hospital cardiac arrest, on-scene socioeconomic status, and accessibility to public automated defibrillators in two large metropolitan areas in Canada and France
Résumé
Aim
To compare walking access times to automated external defibrillators (AEDs) between area-level quintiles of socioeconomic status (SES) in out-of-hospital cardiac arrest (OHCA) cases occurring in 2 major urban regions of Canada and France.
Methods
This was an international, multicenter, retrospective cohort study of adult, non-traumatic OHCA cases in the metropolitan Vancouver (Canada) and Rhône County (France) regions that occurred between 2014 and 2018. We calculated area-level SES for each case, using quintiles of country-specific scores (Q5=most deprived). We identified AED locations from local registries. The primary outcome was the simulated walking time from the OHCA location to the closest AED (continuous and dichotomized by a 3-minute 1-way threshold). We fit multivariate models to analyze the association between OHCA-to-AED walking time and outcomes (Q5 vs. others).
Results
A total of 6,187 and 3,239 cases were included from the Metro Vancouver and Rhône County areas, respectively. In Metro Vancouver Q5 areas (vs. Q1-Q4), areas, AEDs were farther from (79% over 400m from case vs. 67%, p<0.001) and required longer walking times to (97% above 3min vs. 91%, p<0.001) cases. In Rhône Q5 areas, AEDs were closer than in other areas (43% over 400m from case vs. 50%, p=0.01), yet similarly poorly accessible (85% above 3min vs. 86%, p=0.79). In multivariate models, AED access time ≥ 3min was associated with decreased odds of survival at hospital discharge in Metro Vancouver (odds ratio 0.41, 95% CI [0.23-0.74], p=0.003).
Conclusions
Accessibility of public AEDs was globally poor in Metro Vancouver and Rhône, and even poorer in Metro Vancouver’s socioeconomically deprived areas.