Nationwide trends and future projections of out-of-hospital cardiac arrest in Japan: a Bayesian age-period-cohort model and demographic decomposition analysis.
Resuscitation · 2026-03-10 · Registry study
Abstract
BACKGROUND: Japan is a microcosm of an aging society and represents the future for many countries worldwide. We aimed to assess the impact of aging, period, and birth cohort effects on the temporal trends of out-of-hospital cardiac arrest (OHCA) in Japan, and further projected the future OHCA burden. METHODS: We conducted a retrospective, nationwide, population-based study using the All-Japan Utstein Registry between 2009 and 2023. The age-period-cohort model for evaluating and decomposing the effects of age, period, and birth cohort on the incidence of OHCA due to presumed cardiac origin was employed. Furthermore, using the Bayesian age-period-cohort model based on integrated nested Laplace approximations, we projected the OHCA incidence in Japan between 2024 and 2030. RESULTS: During these 15 years, a total of 1,158,691 patients with OHCA of presumed cardiac origin were confirmed. The crude incidence rate per 100,000 persons increased from 50.9 in 2009 to 72.8 in 2023. The OHCA risk increased substantially with increasing age. Compared with patients aged 45-49 years old, the rate ratio (RR) of those aged ≥90 years old was 41.0 (95% confidence interval [CI]; 39.8-42.3). The effect of the 2019-2023 period was similar to that of the 2009-2013 period (RR; 1.00, 95%CI; 0.99-1.02). Compared with patients born in 1948, cohort effects showed increasing the OHCA risk in older birth cohorts, peaking in those born before 1921 (RR; 1.22, 95%CI; 1.20-1.24). In the decomposition analysis regarding changes from 2009 to 2023, population aging and age-specific incidence accounted for 100.5% and 7.1% of the increase and population growth for 7.6% of the decrease in the OHCA number changes (+25,591). As forecasting the OHCA burden, the crude incidence rate per 100,000 persons is projected to increase from 76.0 (95% predictive interval [PI]: 73.6-78.3) in 2024 to 97.2 (95%PI: 66.6-127.7) in 2030. CONCLUSIONS: In Japan, the crude incidence rate of OHCA due to presumed cardiac origin increased from 2009 to 2023, and the incidence is projected to continue increasing through 2030. Japan's aging population and population decline represent a future scenario for countries worldwide, and our projections might apply to nations globally.