ArticleJournal of the American College of Emergency Physicians open2026
Association Between Urban-Rural Geographical Location and 30-Day Survival After Out-of-Hospital Cardiac Arrest.
Article in Journal of the American College of Emergency Physicians open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
Objectives: The aim of this study is to investigate the association between the urban-rural geographical location of out-of-hospital cardiac arrest (OHCA) and 30-day survival after OHCA in Scotland. Methods: For these analyses, data from a population-based study were utilized. In this cohort, all adult, nonemergency medical services (EMS)-witnessed patients with nontraumatic OHCA, for whom the Scottish Ambulance Service attempted resuscitation between April 1, 2011, and March 1, 2020, were included. We used the 2-fold and 6-fold urban-rural classification determined by the Scottish Government to classify cases in our cohort. We used 30-day survival after OHCA as an outcome measure. We performed univariable and multivariable logistic regression to assess the association between urban-rural geographical locations of OHCA and 30-day survival after OHCA. Furthermore, we conducted a mediation analysis to identify potential mediators. Results: This cohort included 20,378 OHCA cases. Patients living in rural areas have a lower odds of 30-day survival after OHCA compared with people living in urban areas (adjusted odds ratio, 1.19; 95% CI, 1.02 to 1.40; adjusted for age, sex, and the Scottish Index of Multiple Deprivation. Early EMS arrival time (a likely proxy for time to first defibrillation) was associated with improved 30-day survival after OHCA and was identified as a probable mediator explaining part of the association found between urban-rural geographical location of OHCA and 30-day survival after OHCA. Conclusion: Policies focusing on reducing time to first defibrillation are likely to be most effective in reducing the difference in 30-day survival after OHCA between urban and rural communities.
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