Journal Article Ahead of print
PubMed: 42481579 DOI: 10.1038/s41598-026-62072-7
Spatial inequalities in out-of-hospital cardiac arrest in Lombardy, Italy are associated with ageing, population density and low income.
Sci Rep
Authors: Roberto Primi, Stefania Bertazzon, Simona Villani, Sara Bendotti, Leila Ulmanova, Alessia Currao, Gianluca Marconi, Maurizio Migliari, Gabriele Mario Perotti, Enrico Baldi, Leonardo De Luca, Simone Savastano
Affiliations
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
- Cardiac Arrest and Resuscitation Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
- Department of Geography, University of Calgary, Calgary, AB, Canada.
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy.
- Agenzia Regionale Emergenza Urgenza AREU Lombardia, Milan, Italy.
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
- Cardiac Arrest and Resuscitation Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Abstract
Out-of-hospital cardiac arrest (OHCA) incidence rate exhibits considerable geographical variations. In Lombardy, the presence of densely populated areas alongside isolated rural municipalities makes analysing health inequalities important. Given their spatial heterogeneity, an explicitly spatial analytical approach is needed. A retrospective ecological study was conducted at the municipal level using data from the Lombardia CARe registry (2021-2024). The incidence of OHCA was calculated for 924 municipalities. Socio-demographic determinants (population density, ageing index and percentage of taxpayers with an annual income below EUR 10,000) were analysed using geographically weighted regression (GWR). Spatial analyses (Moran's I, LISA and Getis-Ord Gi*) were also applied to identify clusters and hotspots. During the study period, 22,201 OHCA events occurred (incidence rate: 126 per 100,000 inhabitants). Marked spatial heterogeneity emerged, with hotspots primarily located in mountainous and hilly areas, and cold-spots predominantly found in urban and lowland zones. GWR identified spatially non-uniform associations: incidence was inversely associated with population density in some areas, whereas it was positively associated with the ageing index and proportion of low-income taxpayers in others. The incidence of OHCA in Lombardy exhibits important spatial disparities. A spatial analytical approach can effectively identify vulnerable areas, guiding public health policies towards equity and spatial justice.
MeSH
Incidence, Income, Out-Of-Hospital Cardiac Arrest, Heart Arrest, Population Density