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Sep
7
2006

A new study suggests that sudden cardiac arrest is linked to poverty. The study validates what many people had assumed. How are such findings to be incorporated into a more just approach to health care? What role does this type of information have in health care reform? In this context, it would have been interesting to know the percentage of these people who had health insurance or access to health care to see if that makes a difference, of course, but such information is not always readily available.

A team of Oregon Health & Science University researchers have found that the incidence of sudden cardiac arrest, one of the nation's most lethal public health problems, was 30 percent to 80 percent higher in the lowest socioeconomic-status neighborhoods in a large urban community than in the high-status areas in that community during the two-year period evaluated. The disparity was most acute for those younger than 65.

The findings were based on a study of 714 cases of sudden cardiac arrest (SCA) in Multnomah County, Ore., reported between February 2002 and January 2004 by the county emergency medical services system, the county medical examiner and 16 area hospitals. At the outset of the study the county had a population of more than 660,000 people.

Ninety-eight percent, or 697, of the SCA cases surveyed had residential addresses in one of the county's 170 census tracts. The tracts were divided into quartiles for each of four measures: median household income, percent of population below the federal poverty level, median home value and percent of population older than 25 with at least a bachelor's degree. For each of the four measures, SCA incidence rates were lowest in the highest socioeconomic status quartiles. Annual incidence of SCAs in census tracts in the lowest versus highest quartiles of median home value was 60.5 versus 35.1 per 100,000. The differential was much more exaggerated for the median home value measure in the younger than 65 population, where it was 34.5 versus 15.1 per 100,000.

"For the information to be relevant to the community, the relationship between socieconomic status and sudden cardiac arrest needed to be addressed in a comprehensive manner," said Sumeet S. Chugh, M.D., principal investigator and associate professor of cardiovascular medicine in the OHSU School of Medicine. Chugh also is section chief of the Heart Rhythm Clinical Service and director of OHSU's new Cardiac Arrhythmia Prevention Center, formerly the Heart Rhythm Research Laboratory.

"It is clear from these findings," said Chugh, "that socioeconomic status matters in the incidence of sudden cardiac arrest as it does for many other diseases. However, there exists a uniform 911 response standard for all regions within the county, which would suggest that additional interventions are necessary to both prevent the higher rates of sudden cardiac arrest observed in poorer neighborhoods as well as improve the outcomes."

The findings, said Chugh, have immediate implications for the deployment of automated external defibrillators (AEDs), which are increasingly found in high-density public places like airports. "Common sense would tell you to go with population density, but these findings would say you should also look at socioeconomic status to determine the most optimal placement of AEDs in the community," Chugh noted.

The annual incidence of sudden cardiac arrest, a problem that results due to a chaotic heart rhythm, averages 200,000 to 300,000 annually in the United States; and the survival rate ranges between 5 percent to 10 percent despite improvements in emergency medical services and widespread training in application of CPR. For more than half of those who suffer an SCA, there are no previous signs of heart disease.

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Join the dialogue here

Sep 14, 2006 4:36:12 PM
Sara says

Armed with this knowledge, why don't our policy makers do battle for health care that does not in effect discriminate based on income? It's is shameful. And very sad.

Sep 18, 2006 2:26:47 PM
Sumeet Chugh says

From a health care provider's perspective, there is clearly much that remains to be accomplished in the way of improving health care policy affecting access to health care. From a researcher's perspective, we are particularly excited about two aspects of this work. Firstly, publication of these findings has brought a significant issue to the fore, which is the first step in the process of addressing the problem. Secondly, our goal is now to tease out the specific reasons why low socioeconomic status resulted in a high rate of sudden cardiac arrest in less affluent neighborhoods of Multnomah County. Our initial findings suggest that differential access to preventive health care could be one culprit, but there are several other possibilities. We are actively working on the design of this research as well as pursuing sources of funding that could make this work possible.

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