The impact of socioeconomic status on paediatric out-of-hospital cardiac arrest incidence and outcomes in Western Australia: a population-based cohort study

Aim To assess differences in incidence, patient characteristics, and survival outcomes by socioeconomic status [SES] in paediatric out-of-hospital cardiac arrest [pOHCA]. Methods OHCA patients aged <15 years attended by emergency medical services [EMS] in Western Australia [WA] between 2015 and 2024 were identified. SES was classified using the Australian Bureau of Statistics Index of Relative Socio-Economic Disadvantage. SES was assigned based on each patient’s residential address and categorised according to WA population-based tertiles (Low, Mid, High). Crude and age-standardised incidence rates per 100,000 population per year were calculated for all pOHCA. Incidence was modelled using negative binomial regression, stratified by SES tertile and paediatric age-group (infant, young child, older child). Survival outcomes (return of spontaneous circulation at hospital arrival [ROSC] and 30-day survival) were descriptively reported by SES tertile. Results A total of 411 pOHCAs attended by EMS were eligible for inclusion. The crude incidence of pOHCA was 9.03 per 100,000 population per year. Nearly half of all events ( n = 201; 48.9%) occurred in children residing in low-SES areas (most disadvantaged). Incidence decreased with increasing socioeconomic advantage. The magnitude of the socioeconomic gradient differed by age (interaction p = 0.015) and was most pronounced in infancy. Overall, 11.7% of children achieved ROSC and 30-day survival was 7.8%, with no consistent socioeconomic differences observed. Conclusion Socioeconomic disadvantage is strongly associated with higher pOHCA incidence, with the gradient most pronounced in early life. These findings highlight the need to better understand the mechanisms underpinning these disparities.