Bystander-initiated CPR in an Asian metropolitan: Does the socioeconomic status matter?

Abstract

Objectives To determine the association of neighborhood socioeconomic status (SES) with bystander-initiated cardiopulmonary resuscitation (CPR) and patient outcomes of out of hospital cardiac arrests (OHCAs) in an Asian metropolitan area. Methods We performed a retrospective study in a prospectively collected cohort from the Utstein registry of adult non-traumatic OHCAs in Taipei, Taiwan. Average real estate value was assessed as the first proxy of SES. Twelve administrative districts in Taipei City were categorized into low versus high SES areas to test the association. The primary outcome was bystander-initiated CPR, and the secondary outcome was patient survival status. Factors associated with bystander-initiated CPR were adjusted for in multivariate analysis. The mean household income was assessed as the second proxy of SES to validate the association. Results From January 1, 2008 to December 30, 2009, 3573 OHCAs received prehospital resuscitation in the community. Among these, 617 (17.3%) cases received bystander CPR. The proportion of bystander CPR in low-SES vs. high-SES areas was 14.5% vs. 19.6% (p < 0.01). Odds ratio of receiving bystander-initiated CPR in low-SES areas was 0.72 (95% confidence interval: [0.60–0.88]) after adjusting for age, gender, witnessed status, public collapse, and OHCA unrecognized by the online dispatcher. Survival to discharge rate was significantly lower in low-SES areas vs. high-SES areas (4.3% vs. 6.8%; p < 0.01). All results above remained consistent in the analyses by mean household income. Conclusions Patients who experienced an OHCA in low-SES areas were less likely to receive bystander-initiated CPR, and demonstrated worse survival outcomes.

Socioeconomic factors associated with outcome after cardiac arrest in patients under the age of 65

“…Lower SES is often associated with lower employment and marriage rates. 9 This could increase the likelihood of social isolation and delay activation of the chain-of-survival with lower rates of witnessed arrest and bystander cardiopulmonary resuscitation (CPR) 10-12 resulting in more severe brain injury and coma on presentation 11 . Non-cardiac etiology of cardiac arrest, such as asphyxia from drug overdose, and higher rates of coma are both associated with worse outcomes after cardiac arrest 13 suggesting an indirect means whereby socioeconomic factors (SE factors), which we define broadly as the sum of SES and associated behaviors and comorbidities, may alter outcomes after OHCA but not IHCA.…”

Non‐traumatic out‐of‐hospital cardiac arrest in rural Taiwan: A retrospective study

“…A lower bystander CPR rate (9.0%) and unsatisfactory quality of chest compression during travel to EDs might have also contributed to this difference . Chiang et al . also reported a low bystander‐initiated CPR rate in areas of lower socioeconomic status.…”

Regions of high out-of-hospital cardiac arrest incidence and low bystander CPR rates in Victoria, Australia

“…These areas tend to have specific racial compositions, and lower levels of education and income [18,33,34]. The next phase of our study intends to explore the demographic factors seen in our high risk regions and whether shifts in the population are responsible for the changes seen over time in our study.…”