Forecasting the burden of out-of-hospital cardiac arrest in a rapidly ageing Asian society: a nationwide age-period-cohort analysis in Singapore.
Resuscitation · 2025-10-27 · Registry study
Abstract
BACKGROUND: The global burden of out-of-hospital cardiac arrest (OHCA) is rising, partly driven by rapidly ageing societies. Population-based studies that forecast this burden are scarce. We quantified temporal trends and projected the future burden of OHCA, positioning Singapore as a microcosm of rapidly ageing Asian societies. METHODS: Using data from 28,229 adult OHCA cases in the national OHCA registry between 2010 and 2021, we evaluated temporal trends using an age-period-cohort model. The contributions of population growth, ageing, and age-specific incidence to changes in OHCA were quantified through demographic decomposition. A Bayesian age-period-cohort model using integrated nested Laplace approximations was employed to forecast OHCA incidence rates through to 2030. RESULTS: Crude and age-standardized OHCA incidence rates rose from 25.0 to 74.0 and from 26.9 to 60.0 per 100,000 between 2010 and 2021, respectively. Risk increased with age (relative risk (RR) 19.73, 95% confidence interval (CI) 13.14-29.62), period effects demonstrated a general increase in OHCA incidence rates (RR 1.69, 95% CI: 1.57-1.82), and cohort effects showed higher risk in more recent birth cohorts (RR 8.42; 95% CI: 3.58-19.85). Decomposition analysis indicated that increased age-specific incidence, population ageing and growth accounted for 62.3%, 23.3% and 16.8% of the rise in cases, respectively. Between 2021 and 2030, the crude incidence rate is projected to increase by 77.3% to 132.1 per 100,000 population, and age-standardized rate by 29.2% to 77.6 per 100,000 population. CONCLUSION: Our projections indicate an escalating burden of OHCA in Singapore driven largely by age-specific risks. This trajectory exemplifies challenges facing ageing urban societies worldwide. Our forecasting framework is adaptable to other settings and underscores the urgent need to integrate OHCA into global disease burden assessments while guiding strategic resource planning.