title: The secular trends in the incidence rate and outcomes of out-of-hospital cardiac arrest in Taiwan--a nationwide population-based study.
abstract: OBJECTIVE
  This study investigated the trends in incidence and mortality of out-of-hospital cardiac arrest (OHCA), as well as factors associated with OHCA outcomes in Taiwan.
  
  
  METHODS
  Our study included OHCA patients requiring cardiopulmonary resuscitation (CPR) upon arrival at the hospital. We used national time-series data on annual OHCA incidence rates and mortality rates from 2000 to 2012, and individual demographic and clinical data for all OHCA patients requiring mechanical ventilation (MV) care from March of 2010 to September of 2011. Analytic techniques included the time-series regression and the logistic regression.
  
  
  RESULTS
  There were 117,787 OHCAs in total. The overall incidence rate during the 13 years was 51.1 per 100,000 persons, and the secular trend indicates a sharp increase in the early 2000s and a decrease afterwards. The trend in mortality was also curvilinear, revealing a substantial increase in the early 2000s, a subsequent steep decline and finally a modest increase. Both the 30-day and 180-day mortality rates had a long-term decreasing trend over the period (p<0.01). For both incidence and mortality rates, a significant second-order autoregressive effect emerged. Among OHCA patients with MV, 1-day, 30-day and 180-day mortality rates were 31.3%, 75.8%, and 86.0%, respectively. In this cohort, older age, the female gender, and a Charlson comorbidity index score ≥ 2 were associated with higher 180-day mortality; patients delivered to regional hospitals and those residing in non-metropolitan areas had higher death risk.
  
  
  CONCLUSIONS
  Overall, both the 30-day and the 180-day mortality rates after OHCA had a long-term decreasing trend, while the 1-day mortality had no long-term decline. Among OHCA patients requiring MV, those delivered to regional hospitals and those residing in non-metropolitan areas tended to have higher mortality, suggesting a need for effort to further standardize and improve in-hospital care across hospitals and to advance pre-hospital care in non-metropolitan areas.
authors: Department of Internal Medicine, Cardinal Tien Hospital, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan.
authors: Cheng-Yi
authors: CY
authors: Wang
authors: Department of Internal Medicine, Cardinal Tien Hospital, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan.
authors: Jen-Yu
authors: JY
authors: Wang
authors: Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan.
authors: Nai-Chi
authors: NC
authors: Teng
authors: Medical Research Center, Cardinal Tien Hospital, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan.
authors: Ting-Ting
authors: TT
authors: Chao
authors: National Health Insurance Administration, Ministry of Health and Welfare, Taipei City, Taiwan.
authors: Shu-Ling
authors: SL
authors: Tsai
authors: The Department of Accounting, The College of Business, Chung Yuan Christian University, Chung Li District, Taoyuan City, Taiwan.
authors: Chi-Liang
authors: CL
authors: Chen
authors: Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan.
authors: Jeng-Yuan
authors: JY
authors: Hsu
authors: Departments of Internal Medicine, Landseed Hospital, Ping Jen District, Taoyuan City, Taiwan.
authors: Chin-Pyng
authors: CP
authors: Wu
authors: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan City, Taiwan.
authors: Chih-Cheng
authors: CC
authors: Lai
authors: Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan.
authors: Likwang
authors: L
authors: Chen
mesh_terms: D016887:Cardiopulmonary Resuscitation; D015897:Comorbidity; D004632:Emergency Medical Services; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000473:pathology; D012727:Sex Characteristics; D016019:Survival Analysis; D013624:Taiwan