{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T23:16:07Z","timestamp":1788909367020,"version":"build-2803163510"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T00:00:00Z","timestamp":1715644800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Previous studies have indicated a poorer survival among women following out-of-hospital cardiac arrest (OHCA), but the mechanisms explaining this difference remain largely uncertain.<\/jats:p>\n                  <jats:p>This study aimed to assess the survival after OHCA among women and men and explore the role of potential mediators, such as resuscitation characteristics, prior comorbidity, and socioeconomic factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This was a population-based cohort study including emergency medical service-treated OHCA reported to the Swedish Registry for Cardiopulmonary Resuscitation in 2010\u20132020, linked to nationwide Swedish healthcare registries. The relative risks (RR) of 30-day survival were compared among women and men, and a mediation analysis was performed to investigate the importance of potential mediators. Total of 43 226 OHCAs were included, of which 14 249 (33.0%) were women. Women were older and had a lower proportion of shockable initial rhythm. The crude 30-day survival among women was 6.2% compared to 10.7% for men [RR 0.58, 95% confidence interval (CI) = 0.54\u20130.62]. Stepwise adjustment for shockable initial rhythm attenuated the association to RR 0.85 (95% CI = 0.79\u20130.91). Further adjustments for age and resuscitation factors attenuated the survival difference to null (RR 0.98; 95% CI = 0.92\u20131.05). Mediation analysis showed that shockable initial rhythm explained \u223c50% of the negative association of female sex on survival. Older age and lower disposable income were the second and third most important variables, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Women have a lower crude 30-day survival following OHCA compared to men. The poor prognosis is largely explained by a lower proportion of shockable initial rhythm, older age at presentation, and lower income.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euae126","type":"journal-article","created":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T17:46:59Z","timestamp":1715708819000},"source":"Crossref","is-referenced-by-count":19,"title":["Underlying reasons for sex difference in survival following out-of-hospital cardiac arrest: a mediation analysis"],"prefix":"10.1093","volume":"26","author":[{"given":"Charlotte","family":"Miedel","sequence":"first","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3539-8317","authenticated-orcid":false,"given":"Martin","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Dragas","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Therese","family":"Dj\u00e4rv","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"},{"name":"Department of Medicine, Karolinska Institutet , Solna , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Nordberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2066-3533","authenticated-orcid":false,"given":"Araz","family":"Rawshani","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy , Gothenburg , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0499-9929","authenticated-orcid":false,"given":"Andreas","family":"Claesson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"},{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy , Gothenburg , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2684-5194","authenticated-orcid":false,"given":"Sune","family":"Forsberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1661-4539","authenticated-orcid":false,"given":"Anette","family":"Nord","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4139-6235","authenticated-orcid":false,"given":"Johan","family":"Herlitz","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"},{"name":"Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work-Life and Social Welfare, University of Bor\u00e5s , Bor\u00e5s , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3038-0027","authenticated-orcid":false,"given":"Gabriel","family":"Riva","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Center for Resuscitation Science, S\u00f6dersjukhuset, Karolinska Institutet , Sjukhusbacken 10, 118 83, Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,5,14]]},"reference":[{"key":"2024053111050529500_euae126-B1","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1016\/j.jacc.2022.02.041","article-title":"Incidence of sudden cardiac death in the European Union","volume":"79","author":"Empana","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2024053111050529500_euae126-B2","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1016\/j.resuscitation.2010.08.006","article-title":"Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies","volume":"81","author":"Berdowski","year":"2010","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B3","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.resuscitation.2019.12.042","article-title":"Survival after out-of-hospital cardiac arrest in Europe - results of the EuReCa TWO study","volume":"148","author":"Gr\u00e4sner","year":"2020","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B4","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1161\/CIRCULATIONAHA.114.009711","article-title":"Recent trends in survival from out-of-hospital cardiac arrest in the United States","volume":"130","author":"Chan","year":"2014","journal-title":"Circulation"},{"key":"2024053111050529500_euae126-B5","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.resuscitation.2022.06.011","article-title":"Association between sex and survival after non-traumatic out of hospital cardiac arrest: a systematic review and meta-analysis","volume":"179","author":"Malik","year":"2022","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B6","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1161\/CIRCOUTCOMES.109.889576","article-title":"Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis","volume":"3","author":"Sasson","year":"2010","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2024053111050529500_euae126-B7","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1016\/j.jacc.2009.07.038","article-title":"Women have a lower prevalence of structural heart disease as a precursor to sudden cardiac arrest: the ore-SUDS (Oregon Sudden Unexpected Death Study)","volume":"54","author":"Chugh","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2024053111050529500_euae126-B8","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s11739-020-02552-4","article-title":"Gender differences and survival after an out-of-hospital cardiac arrest: a systematic review and meta-analysis","volume":"16","author":"Feng","year":"2021","journal-title":"Intern Emerg Med"},{"key":"2024053111050529500_euae126-B9","doi-asserted-by":"crossref","first-page":"2699","DOI":"10.1161\/hc4701.099784","article-title":"Out-of-hospital cardiac arrest in men and women","volume":"104","author":"Kim","year":"2001","journal-title":"Circulation"},{"key":"2024053111050529500_euae126-B10","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1016\/j.jacc.2004.03.031","article-title":"Gender differences in ventricular arrhythmia recurrence in patients with coronary artery disease and implantable cardioverter-defibrillators","volume":"43","author":"Lampert","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2024053111050529500_euae126-B11","doi-asserted-by":"crossref","first-page":"3824","DOI":"10.1093\/eurheartj\/ehz297","article-title":"Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest","volume":"40","author":"Blom","year":"2019","journal-title":"Eur Heart J"},{"key":"2024053111050529500_euae126-B12","author":"Statistics Sweden"},{"key":"2024053111050529500_euae126-B13","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1161\/CIR.0000000000000144","article-title":"Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation","volume":"132","author":"Perkins","year":"2015","journal-title":"Circulation"},{"key":"2024053111050529500_euae126-B14","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.resuscitation.2012.12.026","article-title":"Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden","volume":"84","author":"Str\u00f6ms\u00f6e","year":"2013","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B15","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"key":"2024053111050529500_euae126-B16","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s10654-019-00511-8","article-title":"The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research","volume":"34","author":"Ludvigsson","year":"2019","journal-title":"Eur J Epidemiol"},{"key":"2024053111050529500_euae126-B17","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified poisson regression approach to prospective studies with binary data","volume":"159","author":"Zou","year":"2004","journal-title":"Am J Epidemiol"},{"key":"2024053111050529500_euae126-B18","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1002\/sim.7977","article-title":"Multiple mediation analysis with survival outcomes: with an application to explore racial disparity in breast cancer survival","volume":"38","author":"Yu","year":"2019","journal-title":"Stat Med"},{"key":"2024053111050529500_euae126-B19","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.resuscitation.2021.03.020","article-title":"Sex differences in outcomes for out-of-hospital cardiac arrest in the United States","volume":"163","author":"Kotini-Shah","year":"2021","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B20","doi-asserted-by":"crossref","first-page":"2116","DOI":"10.1161\/CIRCULATIONAHA.110.966333","article-title":"Factors associated with pulseless electric activity versus ventricular fibrillation: the Oregon sudden unexpected death study","volume":"122","author":"Teodorescu","year":"2010","journal-title":"Circulation"},{"key":"2024053111050529500_euae126-B21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.resuscitation.2007.06.027","article-title":"Characteristics and outcome in out-of-hospital cardiac arrest when patients are found in a non-shockable rhythm","volume":"76","author":"Herlitz","year":"2008","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B22","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.resuscitation.2020.11.012","article-title":"Can a shockable initial rhythm identify out-of-hospital cardiac arrest patients with a short no-flow time?","volume":"158","author":"Cournoyer","year":"2021","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B23","doi-asserted-by":"crossref","first-page":"e004710","DOI":"10.1161\/CIRCOUTCOMES.118.004710","article-title":"Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public","volume":"11","author":"Blewer","year":"2018","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2024053111050529500_euae126-B24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0300-9572(02)00047-3","article-title":"Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest","volume":"54","author":"Waalewijn","year":"2002","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B25","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.resuscitation.2017.11.064","article-title":"Association of initial recorded rhythm and underlying cardiac disease in sudden cardiac arrest","volume":"122","author":"Kauppila","year":"2018","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B26","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1053\/hj.1998.v136.90226","article-title":"Sudden coronary death in women","volume":"136","author":"Kannel","year":"1998","journal-title":"Am Heart J"},{"key":"2024053111050529500_euae126-B27","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/0002-8703(86)90155-9","article-title":"Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population","volume":"111","author":"Lerner","year":"1986","journal-title":"Am Heart J"},{"key":"2024053111050529500_euae126-B28","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1161\/01.CIR.0000065223.21530.11","article-title":"Prospective study of sudden cardiac death among women in the United States","volume":"107","author":"Albert","year":"2003","journal-title":"Circulation"},{"key":"2024053111050529500_euae126-B29","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1093\/europace\/euy067","article-title":"Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society","volume":"20","author":"Linde","year":"2018","journal-title":"Europace"},{"key":"2024053111050529500_euae126-B30","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1161\/01.CIR.93.6.1170","article-title":"Sex differences in cardiac arrest survivors","volume":"93","author":"Albert","year":"1996","journal-title":"Circulation"},{"key":"2024053111050529500_euae126-B31","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.resuscitation.2021.08.034","article-title":"Sex differences in the association of comorbidity with shockable initial rhythm in out-of-hospital cardiac arrest","volume":"167","author":"van Dongen","year":"2021","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B32","doi-asserted-by":"crossref","first-page":"3439","DOI":"10.1001\/archinte.160.22.3439","article-title":"Out-of-hospital cardiac arrest in octogenarians and nonagenarians","volume":"160","author":"Kim","year":"2000","journal-title":"Arch Intern Med"},{"key":"2024053111050529500_euae126-B33","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.resuscitation.2015.05.031","article-title":"Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study","volume":"94","author":"Libungan","year":"2015","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B34","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1016\/j.resuscitation.2014.07.017","article-title":"Trends in survival among elderly patients with out-of-hospital cardiac arrest: a prospective, population-based observation from 1999 to 2011 in Osaka","volume":"85","author":"Kitamura","year":"2014","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B35","doi-asserted-by":"crossref","first-page":"109603","DOI":"10.1016\/j.resuscitation.2022.09.016","article-title":"Sex differences in the association between bystander CPR and survival for out-of-hospital cardiac arrest","volume":"182","author":"Ok Ahn","year":"2022","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B36","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.hrthm.2012.12.002","article-title":"Antipsychotic drugs are associated with pulseless electrical activity: the Oregon sudden unexpected death study","volume":"10","author":"Teodorescu","year":"2013","journal-title":"Heart Rhythm"},{"key":"2024053111050529500_euae126-B37","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.resuscitation.2016.08.024","article-title":"Clinical predictors of shockable versus non-shockable rhythms in patients with out-of-hospital cardiac arrest","volume":"108","author":"Granfeldt","year":"2016","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B38","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.resuscitation.2019.05.018","article-title":"Socio-economic differences in incidence, bystander cardiopulmonary resuscitation and survival from out-of-hospital cardiac arrest: a systematic review","volume":"141","author":"van Nieuwenhuizen","year":"2019","journal-title":"Resuscitation"},{"key":"2024053111050529500_euae126-B39","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/S0196-0644(87)80576-0","article-title":"The location of collapse and its effect on survival from cardiac arrest","volume":"16","author":"Litwin","year":"1987","journal-title":"Ann Emerg Med"},{"key":"2024053111050529500_euae126-B40","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1136\/heart.88.6.579","article-title":"Characteristics and outcome among patients having out of hospital cardiac arrest at home compared with elsewhere","volume":"88","author":"Herlitz","year":"2002","journal-title":"Heart"},{"key":"2024053111050529500_euae126-B41","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1016\/j.amjcard.2018.12.038","article-title":"Out-of-Hospital cardiac arrest at home in Japan","volume":"123","author":"Kiyohara","year":"2019","journal-title":"Am J Cardiol"}],"container-title":["Europace"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/europace\/advance-article-pdf\/doi\/10.1093\/europace\/euae126\/57655038\/euae126.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/26\/5\/euae126\/58012984\/euae126.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/26\/5\/euae126\/58012984\/euae126.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T20:12:34Z","timestamp":1717186354000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/doi\/10.1093\/europace\/euae126\/7672945"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5]]},"references-count":41,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5,2]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euae126","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5]]},"published":{"date-parts":[[2024,5]]},"article-number":"euae126"}}