Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Tijssen, Janice A.

2nd Supervisor

Anderson, Kelly K.

Co-Supervisor

Abstract

Paediatric out-of-hospital cardiac arrest (POHCA) is associated with poor survival and severe neurological sequelae. This thesis aims to explore the relationship between sociodemographic factors and POHCA. The findings from our systematic review indicate that there are racial disparities in POHCA risk and in the provision of bystander cardiopulmonary resuscitation. There was little evidence of sociodemographic disparities in bystander defibrillation, survival and neurological outcome, particularly across adjusted analyses. The findings from our case-control study in Ontario, Canada, indicate that children living in marginalized areas have an elevated risk of experiencing POHCA. We also found that children living in northern urban or southern rural areas had a higher risk of POHCA, relative to children living in southern urban areas. In contrast, child immigrants and maternal immigrants had a lower risk of POHCA, relative to the general population. These findings highlight the importance of prioritizing at-risk communities in POHCA prevention and intervention efforts.

Summary for Lay Audience

Cardiac arrest is a critical and time-sensitive event that occurs when the heart suddenly stops beating. In the absence of immediate medical attention, reduced blood flow to the brain and other vital organs leads to patient collapse, and loss of consciousness with no detectable pulse. Paediatric out-of-hospital cardiac arrest (POHCA) is when a child experiences cardiac arrest, in an out-of-hospital setting. POHCA is associated with significant mortality and poor neurological outcomes. Bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) application, and shorter emergency medical service (EMS) response times can increase the likelihood of neurologically favourable survival, yet recent evidence indicates that there may be racial and socioeconomic inequities in the provision of these services. The objectives of this thesis were (1) to summarize the prior evidence on the impact of sociodemographic factors across different stages of POHCA, and (2) to quantify the association between sociodemographic indicators and POHCA risk in Ontario, Canada. We searched the literature for evidence in these areas and reviewed 18 articles that met our eligibility criteria. The findings from our review indicate that there are racial and ethnic disparities in POHCA risk and in the provision of bystander CPR, however there was little evidence of sociodemographic disparities in bystander AED application, survival, and neurological outcome. In our second study, we used health administrative databases to assess the relationship between sociodemographic factors and POHCA risk in Ontario, Canada. The findings from this study indicate that children living in areas with high levels of marginalization have an elevated risk of experiencing POHCA. We also found that children living in northern urban or southern rural areas had a higher risk of POHCA, relative to children living in southern urban areas. In contrast, child immigrants and maternal immigrants had a lower risk of POHCA, relative to the general population. These findings highlight the importance of prioritizing at-risk communities in POHCA prevention and intervention efforts, including increased education and awareness around POHCA and its risk factors, as well as improved access to high-quality CPR training.

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