title: Regional variability in survival outcomes of out-of-hospital cardiac arrest: the All-Japan Utstein Registry.
abstract: OBJECTIVE
  There is a paucity of studies on the degree of regional variability in out-of-hospital cardiac arrest (OHCA) outcomes, particularly in neurological outcome. This study aimed to determine whether there is a significant regional variation in survival outcomes of OHCA across Japan.
  
  
  METHODS
  We analyzed a prospective, nation-wide, population-based database (All-Japan Utstein Registry) involving all Japanese individuals who had non-traumatic OHCA resuscitated by emergency responders from January 2005 through December 2010. The primary study endpoint was favourable neurological survival at 1 month, defined as Cerebral Performance Category 1 or 2. We compared unadjusted and multivariable-adjusted rates of the outcome among seven geographic regions.
  
  
  RESULTS
  In the total catchment population of 128 million, there were 539,641 non-traumatic OHCA patients. Unadjusted neurologically favourable survival varied across regions from 1.9% to 3.1% (rate difference, 1.2%; 95%CI, 1.0-1.3%); the Northeast region had a significantly lower rate compared to the Midwest region (unadjusted rate ratio, 0.62; 95%CI, 0.60-0.64). This disparity became larger after adjusting for patient- and prehospital-level confounders (adjusted rate ratio, 0.52; 95%CI, 0.51-0.54). Among 35,153 OHCA patients with return of spontaneous circulation, unadjusted neurologically favourable survival varied from 26.4% to 34.7% (rate difference, 8.3%; 95%CI, 6.6-10.1%); the East region had a significantly lower rate compared to the Midwest region (adjusted rate ratio, 0.72; 95%CI, 0.68-0.76).
  
  
  CONCLUSIONS
  In this prospective, nation-wide, population-based study in Japan, we found a two-fold regional difference in neurologically favourable survival after OHCA, suggesting regional disparities in prehospital care and in-hospital post-resuscitation care.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. khasegawa1@partners.org
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsugawa
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraide
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001775:Blood Circulation; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration; D060731:Emergency Responders; D005260:Female; D062306:Geography, Medical; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D015996:Survival Rate; D013997:Time Factors
keywords: Emergency medical service; Epidemiology; Health services research; Out-of-hospital cardiac arrest; Outcomes; Regional variation