title: Nationwide and regional trends in survival from out-of-hospital cardiac arrest in Japan: A 10-year cohort study from 2005 to 2014.
abstract: Little is known about the most recent nationwide and regional trends in out-of-hospital cardiac arrest (OHCA) outcome. We therefore sought to investigate the recent nationwide and regional trends in OHCA outcome in Japan.
  
  
  
  Using nationwide, population-based OHCA registry in Japan, we evaluated outcome from emergency-medical-services resuscitated OHCA of medical origin between 2005 and 2014. A total of 861,756 OHCA patients of medical origin were eligible for our analyses. We assessed annual nationwide OHCA outcome and regional trend among seven representative regions between two periods, 2005-2009 and 2010-2014. The primary outcome was one-month survival with favourable neurological outcome, defined as Cerebral Performance Category scale of 1 or 2.
  
  
  
  The nationwide 1-month survival with favourable neurological outcome increased from 1.1% to 2.3% in OHCA of medical origin. Using multivariable analysis, favourable neurological outcome in 2014 significantly increased (adjusted OR, 2.81; 95% CI, 2.57-3.07), compared with that in 2005. Among seven regions, favourable neurological outcome from OHCA of medical origin varied in the 2005-2009 period (1.3%-2.2%) and 2010-2014 period (1.7%-2.8%). Using multivariable analysis, these disparities persisted in 2005-2009 (the range of adjusted OR, 0.88-1.85) and 2010-2014 (the range of adjusted OR, 1.00-1.83) periods, using Kanto region as the reference. All regions showed increase in favourable neurological outcome during 2010-2014 period (the range of adjusted OR, 1.44-1.82), using 2005-2009 period as the reference.
  
  
  
  We found nationwide and regional improvement of favourable neurological outcomes from OHCA of medical origin with persistent regional variation.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Masashi
authors.initials: M
authors.lastname: Okubo
authors.affiliation: Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kiyohara
authors.affiliation: Kyoto University Health Service, Kyoto, Japan. Electronic address: iwami.taku.8w@kyoto-u.ac.jp.
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Kitamura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D012042:Registries; D000073859:Survivorship; D055815:Young Adult
keywords: Cardiopulmonary resuscitation; Out-of-hospital cardiac arrest; Regional variation; Survival outcome trend