Association of Neighborhood Characteristics with Bystander-Initiated CPR

Abstract

BACKGROUND For persons who have an out-of-hospital cardiac arrest, the probability of receiving bystander-initiated cardiopulmonary resuscitation (CPR) may be influenced by neighborhood characteristics. METHODS We analyzed surveillance data prospectively submitted from 29 U.S. sites to the Cardiac Arrest Registry to Enhance Survival between October 1, 2005, and December 31, 2009. The neighborhood in which each cardiac arrest occurred was determined from census-tract data. We classified neighborhoods as high-income or low-income on the basis of a median household income threshold of $40,000 and as white or black if more than 80% of the census tract was predominantly of one race. Neighborhoods without a predominant racial composition were classified as integrated. We analyzed the relationship between the median income and racial composition of a neighborhood and the performance of bystander-initiated CPR. RESULTS Among 14,225 patients with cardiac arrest, bystander-initiated CPR was provided to 4068 (28.6%). As compared with patients who had a cardiac arrest in high-income white neighborhoods, those in low-income black neighborhoods were less likely to receive bystander-initiated CPR (odds ratio, 0.49; 95% confidence interval [CI], 0.41 to 0.58). The same was true of patients with cardiac arrest in neighborhoods characterized as low-income white (odds ratio, 0.65; 95% CI, 0.51 to 0.82), low-income integrated (odds ratio, 0.62; 95% CI, 0.56 to 0.70), and high-income black (odds ratio, 0.77; 95% CI, 0.68 to 0.86). The odds ratio for bystander-initiated CPR in high-income integrated neighborhoods (1.03; 95% CI, 0.64 to 1.65) was similar to that for high-income white neighborhoods. CONCLUSIONS In a large cohort study, we found that patients who had an out-of-hospital cardiac arrest in low-income black neighborhoods were less likely to receive bystander-initiated CPR than those in high-income white neighborhoods. (Funded by the Centers for Disease Control and Prevention and others.)

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

“…[4,5] Despite clear evidence of benefit, The rates of bystander CPR vary between communities from 10 -75%. [14] Barriers to bystanders being willing to initiate CPR include socioeconomic deprivation, difficulty in diagnosing cardiac arrest, panic, fear of disease, fear of harming the victim or fear of performing CPR incorrectly. [15][16][17] Victim characteristics associated with less willingness for bystander CPR initiation include being unknown to the rescuer, appearing unkempt, evidence of drug use, the presence of blood, or vomit.…”

Population Movement and Sudden Cardiac Arrest Location

“…Fifth, interesting existing data have demonstrated the influence of neighborhood socioeconomic status on the incidence and management of SCA. 44 However, in terms of SCA occurring in public places, this "time of exposition" (influence of neighborhood socioeconomic status) to neighborhood appears of limited value, especially in a city like Paris with very high population movement and consequently considerable heterogeneity in socioeconomic status. The extent to which the association between SCA and major train station may be driven by different (lower) socioeconomic status needs to be examined in further studies.…”

Geographic factors are associated with increased risk for out-of hospital cardiac arrests and provision of bystander cardio-pulmonary resuscitation in Singapore

“…Studies have reported that OHCA cases happening in lower socioeconomic neighborhoods were less likely to receive BCPR [22][23][24][25][26][27] and survive 23,27,28 compared to those occurred at high socio-economic neighborhoods. But, one study showed an inverse relation between higher property values and survival outcomes.…”