The secular trends in the incidence rate and outcomes of out-of-hospital XXXX in Taiwan--a nationwide population-based study.

@entity1 @entity1167
OBJECTIVE: This study investigated the trends in incidence and mortality of out-of-hospital @entity1167 (OHCA), as well as factors associated with OHCA outcomes in Taiwan. METHODS: Our study included OHCA @entity1 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 @entity1 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 @entity1 , 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 @entity1 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; @entity1 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 @entity1 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.
