# Gender disparities in out-of-hospital cardiac arrest: implications for public health and bystander interventions in Zhengzhou

## TL;DR

This study finds significant gender disparities in out-of-hospital cardiac arrest outcomes in Zhengzhou, China, with women less likely to receive timely interventions and having lower survival rates.

## Contribution

The study provides China-specific evidence on gender disparities in OHCA outcomes and highlights the need for gender-sensitive public health strategies.

## Key findings

- Women with OHCA were significantly older and less likely to have their arrest witnessed or receive bystander CPR.
- Female OHCA patients had lower rates of AED use and shockable rhythms, contributing to reduced ROSC rates.
- Public location arrests were less common among women, further limiting bystander intervention opportunities.

## Abstract

Out-of-hospital cardiac arrest (OHCA) remains a critical public health crisis in China, with survival rates below 1%, notably lower than those reported in developed nations (10%–12%). Gender disparities have emerged as crucial determinants of OHCA outcomes; however, China-specific evidence remains limited.

We conducted a retrospective cohort study of 3,272 adult non-traumatic OHCA patients treated at the Zhengzhou Emergency Medical Rescue Center between 2017 and 2020. Patient characteristics and interventions were analyzed using multivariable logistic regression to assess their associations with prehospital return of spontaneous circulation (ROSC).

Among 3,272 OHCA patients, women accounted for 27.6% (n = 902), and were significantly older than men (70.1 vs. 61.1 years, p < 0.001). Compared with men, women experienced lower rates of witnessed arrest (51.2% vs. 64.0%, p < 0.001), CPR from bystanders (4.8% vs. 7.3%, p = 0.01), AED use (8.9% vs. 12.4%, p = 0.005), and shockable initial rhythm (6.7% vs. 16.1%, p < 0.001). In addition, women were less likely to experience an OHCA in a public location (13.7% vs. 26.4%, p < 0.001). The female sex remained independently associated with a significantly lower prehospital ROSC rate (OR: 0.26; 95% CI: 0.13–0.53, p < 0.001).

Significant gender disparities were identified in prehospital outcomes of OHCA patients in Zhengzhou. Compared with men, women were older and less likely to experience a cardiac arrest in public locations, have the event witnessed, receive cardiopulmonary resuscitation (CPR) from a bystander, present with a shockable rhythm, or require an automated external defibrillator (AED). These factors collectively contributed to substantially lowered prehospital ROSC rates among women. Targeted public health strategies–such as expanding inclusive CPR training, promoting gender-sensitive AED use, enhancing community awareness of female resuscitation, and optimizing emergency medical service protocols–are urgently required to reduce these disparities.