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Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and a highly variable survival rate. Few studies have focused on outcomes in rural and urban groups while also evaluating underlying diseases and prehospital factors for OHCAs. To investigate the relationship between the patient's underlying disease and outcomes of OHCAs in urban areas versus those in rural areas. We reviewed the emergency medical service (EMS) database for information on OHCA patients treated between January 2015 and December 2019, and collected