Ph.D. Defense by Sidsel Gamborg Møller
Sidsel Gamborg Møllerwill defend her Ph.D. thesis “ Socioeconomic differences in care and outcomes after out-of-hospital cardiac arrest"
20.04.2021 kl. 11.00 - 14.00
11.00 Opening by the Moderator Christian Torp-Pedersen
11.05 PhD lecture by Sidsel Gamborg Møller
12.00 Questions and comments from the Committee
Questions and comments from the audience at the Moderator’s discretion
14.00 Conclusion of the session by the Moderator
The Faculty Council has appointed the following adjudication committee to evaluate the thesis and the associated lecture:
Dr. Hanne Berg Ravn, Professor, chief physician, dr.med. PhD., Denmark
Dr. Johan Herlitz, Professor, MD, PhD., Sweden
Kirsten Schultz Petersen, Aalborg University, Denmark
Christian Torp-Pedersen, Aalborg University, Denmark
Despite improvements over time, out-of-hospital cardiac arrest (OHCA) remains a public health problem worldwide with a poor prognosis. Socioeconomic differences in OHCA patients have been of increasing interest, but mainly focused on area-level socioeconomic differences in pre-hospital factors and especially bystander interventions. The aim of this thesis was therefore to examine whether patient socioeconomic factors were associated with care and outcomes after OHCA.
We included OHCA patients ≥30 years of age from the Danish Cardiac Arrest Registry (2001-2014) of presumed cardiac cause and not-witnessed by the emergency medical service (EMS), and divided the patients in groups of income as primary exposure and education as supplementary. For Paper I we included all OHCA patients without missing information on location of arrest, witnessed status and bystander cardiopulmonary resuscitation (CPR), in Paper II we included all OHCA patients with a hospital admission after OHCA, and in Paper III we included all 30-day survivors from OHCA. We examined the associations between patient income (and education), pre-hospital factors and 30-day survival in Paper I, in-hospital coronary procedures and 30-day survival in Paper II, and long-term outcomes (1- and 5-year survival, anoxic brain damage or nursing home admission, and return to work among previously workers prior to arrest <66 years) in Paper III.
In all three papers patients with higher income were associated with more positive prognostic characteristics as younger age, less comorbidities, more public located witnessed arrests and more bystander CPR. In Paper I we found that patients with higher income had higher odds for bystander CPR in adjusted analyses, and in relation to 30-day survival, the patients with the highest income had 25.3% higher survival compared to patients with the lowest income when including both important patient- and cardiac arrest-related factors. In Paper II we found that patients with higher income received more coronary angiographies compared to patients with the lowest income, whereas overall no socioeconomic gradient was observed in revascularization procedures among the patients receiving a coronary angiography. We also observed higher odds for 30-day survival in patients with higher income compared to patients with the lowest income in both patients with and without performed coronary angiography day 0-1 after OHCA. In Paper III we found that high-income patients had higher probability for 1- and 5-year survival, lower risk of 1- and 5-year anoxic brain damage or nursing home admission and higher probability of 1- and 5-year return to work (among previously workers prior to arrest <66 years of age), compared to low-income patients.
Overall socioeconomic differences were observed in both care and outcomes after OHCA and neither important patient- nor cardiac arrest-characteristics explained the observed associations. The thesis highlights a great potential to improve care further through greater understanding of socioeconomic differences as a first step towards minimizing these differences i
Department of Health Science and Technology
Ph.D. Defense take place via Zoom.
16.04.2021 kl. 12.00