Dataset Information

Impact of the consumption tax rate increase on out-of-hospital cardiac arrest in Japan: an interrupted time series analysis.

ABSTRACT:

Objectives

The Japanese government increased the consumption tax rate from 5% to 8% on 1 April 2014. The impact of this policy on the incidence of out-of-hospital cardiac arrest (OHCA) is unknown. Thus, we aimed to evaluate a potential association between the consumption tax rate increase and OHCA.

Design

An interrupted time series design.

Setting

National registry data for all cases of OHCA in Japan.

Participants

All OHCA cases of presumed cardiac origin in Japan between January 2005 and December 2016.

Primary outcome measure

We used a quasiexperimental design with interrupted time series analysis to investigate whether the consumption tax rate increase was associated with changes in OHCA trends after adjusting for baseline trends. The effective date of the consumption tax rate increase (1 April 2014) was used to split the OHCA data into categories of before and after the change.

Results

In total, 808 055 OHCAs of presumed cardiac origin were reported during the study period. Prior to the consumption tax rate increase, the mean monthly OHCA rate was 5.12 cases per 100 000 population (mean monthly count: 5483.45). After adjusting for underlying trends, there was a substantial step change in the incidence of OHCAs (relative risk (RR): 0.921; 95% CI 0.889 to 0.955).

Conclusions

The implementation of the consumption tax rate increase was associated with a significant decrease in the incidence of OHCAs in Japan.

SUBMITTER: Onozuka D

PROVIDER: S-EPMC6588978 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Objectives:Patient outcomes after out-of-hospital cardiac arrest (OHCA) varies at multilevel (geographical regions, emergency medical service agencies and receiving hospitals) in the USA. However, it remains unclear whether there is a variation in patient outcomes after OHCA between relevant units of the healthcare system such as receiving hospitals in Japan. Therefore, we aimed to quantify the variation in patient outcomes after OHCA between receiving hospitals in Japan.Design:Secondary analysis of the prospective multicentre OHCA registry.Setting:The Japan Association for Acute Medicine OHCA Registry, a prospective multicentre OHCA registry, including 73 medical institutions in Japan.Participants:9303 adults (≥18 years old) with OHCA of medical origin, treated at 67 hospitals from June 2014 to December 2015.Primary and secondary outcome measures:The primary outcome was 1-month survival after OHCA. The secondary outcome was favourable functional status at 1 month, defined as cerebral performance category scale 1 or 2. We constructed a series of multivariable hierarchical logistic regression models predicting outcomes, accounting for patient-level variables and clustering of patients within hospitals. We evaluated the adjusted 1-month survival and functional outcome for each hospital, ranked hospitals for each outcome and calculated median ORs (MORs) to quantify the between-hospital variation in outcomes.Results:The prevalence of 1-month survival after OHCA was 7.1% (663/9303) and that of favourable functional outcome was 3.6% (331/9303). After adjustment for patient-level factors, we observed variations in 1-month survival (range, 1.6%-13.8%; adjusted MOR 1.34; 95% CI 1.16 to 1.67) and favourable functional outcome (range, 0.7%-7.3%; adjusted MOR 1.53; 95% CI 1.10 to 2.24) between hospitals.Conclusions:We found substantial variations in patient outcomes after OHCA within a large group of hospitals in Japan, despite adjustment for patient factors that are known to be associated with different outcomes.