The effect of age, gender, economic state, and urbanization on the temporal trend in sudden cardiac arrest: a nationwide population-based cohort study

Sudden cardiac arrest (SCA) has not been well studied in Asian countries. This study investigated the temporal trends in the incidence and outcomes of SCA and the impact of age, gender, economic state, and urbanization on SCA using a nationwide population-based sample cohort of South Korea. In the Korean National Health Insurance Service—Sample Cohort consisting of one million persons from 2003 through 2013, we identified 5,675 (0.56%) patients with SCA using ICD-10 code I46 and I49.0. We evaluated the impact of the age, gender, household income, and urbanization level on the incidence and outcome of SCA. During the study period, the overall age- and gender-adjusted annual incidence of SCA increased by 46.9% from 30.9 in 2003 to 45.4 in 2013 (per 100,000 person-years, p < 0.001 for trend). The medical cost per 100,000 person-years also greatly increased about four times (p < 0.001 for trend). The overall adjusted survival to hospital discharge rate increased from 8.9% in 2003 to 13.2% in 2013 (adjusted rate ratio per year 1.05; p < 0.001 for trend). Old age and low household incomes of the population was related to increased SCA and poor survival to hospital discharge rate. The proportion of patients with intensive or advanced therapeutic modalities after SCA greatly increased from 1.6% in 2003 to 10.0% in 2013 (p < 0.001 for trend). This increase was consistent regardless of age, gender, economic state, and urbanization level. Although the incidence of SCA was increased, the outcome was improved for the decade. However, in the elderly and low-income population, the incidence of SCA continued to rise and survival outcome was not improved.