J Korean Med Sci.  2024 Mar;39(9):e86. 10.3346/jkms.2024.39.e86.

Spatiotemporal Analysis of Out-ofHospital Cardiac Arrest Incidence and Survival Outcomes in Korea (2009–2021)

• Lee N
• Jung S
• Ro YS
• Park JH
• Hwang Ss

• KMID: 2553335
• DOI: http://doi.org/10.3346/jkms.2024.39.e86

Abstract

Background
Out-of-hospital cardiac arrest is a major public health concern in Korea. Identifying spatiotemporal patterns of out-of-hospital cardiac arrest incidence and survival outcomes is crucial for effective resource allocation and targeted interventions. Thus, this study aimed to investigate the spatiotemporal epidemiology of out-of-hospital cardiac arrest in Korea, with a focus on identifying high-risk areas and populations and examining factors associated with prehospital outcomes.
Methods
We conducted this population-based observational study using data from the Korean out-of-hospital cardiac arrest registry from January 2009 to December 2021. Using a Bayesian spatiotemporal model based on the Integrated Nested Laplace Approximation, we calculated the standardized incidence ratio and assessed the relative risk to compare the spatial and temporal distributions over time. The primary outcome was out-ofhospital cardiac arrest incidence, and the secondary outcomes included prehospital return of spontaneous circulation, survival to hospital admission and discharge, and good neurological outcomes.
Results
Although the number of cases increased over time, the spatiotemporal analysis exhibited a discernible temporal pattern in the standardized incidence ratio of out-ofhospital cardiac arrest with a gradual decline over time (1.07; 95% credible interval [CrI], 1.04–1.09 in 2009 vs. 1.00; 95% CrI, 0.98–1.03 in 2021). The district-specific risk ratios of survival outcomes were more favorable in the metropolitan and major metropolitan areas. In particular, the neurological outcomes were significantly improved from relative risk 0.35 (0.31–0.39) in 2009 to 1.75 (1.65–1.86) in 2021.
Conclusion
This study emphasized the significance of small-area analyses in identifying high-risk regions and populations using spatiotemporal analyses. These findings have implications for public health planning efforts to alleviate the burden of out-of-hospital cardiac arrest in Korea.

Keyword

Incidence; Out-of-Hospital Cardiac Arrest; Spatiotemporal Analysis; Bayesian; Survival

Figure

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  Fig. 1 Standardized incidence ratios, population densities and aging indices at the district level.

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  Fig. 2 Temporal plot of relative risk of OHCA incidence and survival outcomes from 2009 to 2021.OHCA = out-of-hospital cardiac arrest, ROSC = return of spontaneous circulation.

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  Fig. 3 Geographical distribution map of the relative risk of out-of-hospital cardiac arrest. survival outcomes in the Republic of Korea, 2009–2021. (A) Prehospital return of spontaneous circulation. (B) Survival to hospital admission. (C) Survival to hospital discharge. (D) Good neurological recovery.

• 

  Fig. 4 EP for a specific threshold (relative risk > 1.25) of the OHCA incidence and survival outcomes. The EP was estimated from the model via spatiotemporal poisson regression. (A) Incidence of OHCA. (B) Prehospital return of spontaneous circulation. (C) Survival to hospital admission. (D) Survival to hospital discharge. (E) Good neurological recovery. Regarding incidence, risk areas are identified by red marking and survival outcomes by blue to identify areas with improved results. Regional emergency medical centers in the area marked as black dots.EP = exceedance probability, OHCA = out-of-hospital cardiac arrest.

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