Cardiopulmonary Resuscitation Training Disparities in the United States

Abstract

BackgroundBystander cardiopulmonary resuscitation (CPR) is associated with increased survival from cardiac arrest, yet bystander CPR rates are low in many communities. The overall prevalence of CPR training in the United States and associated individual‐level disparities are unknown. We sought to measure the national prevalence of CPR training and hypothesized that older age and lower socioeconomic status would be independently associated with a lower likelihood of CPR training.Methods and ResultsWe administered a cross‐sectional telephone survey to a nationally representative adult sample. We assessed the demographics of individuals trained in CPR within 2 years (currently trained) and those who had been trained in CPR at some point in time (ever trained). The association of CPR training and demographic variables were tested using survey weighted logistic regression. Between September 2015 and November 2015, 9022 individuals completed the survey; 18% reported being currently trained in CPR, and 65% reported training at some point previously. For each year of increased age, the likelihood of being currently CPR trained or ever trained decreased (currently trained: odds ratio, 0.98; 95% CI, 0.97–0.99; P<0.01; ever trained: OR, 0.99; 95% CI, 0.98–0.99; P=0.04). Furthermore, there was a greater then 4‐fold difference in odds of being currently CPR trained from the 30–39 to 70–79 year old age groups (95% CI, 0.10–0.23). Factors associated with a lower likelihood of CPR training were lesser educational attainment and lower household income (P<0.01 for each of these variables).ConclusionsA minority of respondents reported current training in CPR. Older age, lesser education, and lower income were associated with reduced likelihood of CPR training. These findings illustrate important gaps in US CPR education and suggest the need to develop tailored CPR training efforts to address this variability.

Knowledge of and attitudes towards cardiopulmonary resuscitation among junior doctors and medical students in Upper Egypt: cross-sectional study

“…Restrictions due to cost can be especially problematic in underprivileged institutions with large student bodies (and high student/teacher ratios). A previous study detected significant disparities in CPR training partially attributable to financial reasons, with lower income areas in the United States lacking in bystander CPR training [15]. In line with this, Upper Egyptian governorates like Beni-Suef are the least privileged governorates in Egypt in terms of average household income and educational attainment [16].…”

“…In line with this, Upper Egyptian governorates like Beni-Suef are the least privileged governorates in Egypt in terms of average household income and educational attainment [16]. Such financial factors may represent barriers that prevent junior doctors and medical students with relatively low incomes from receiving CPR training independently [15]. However, as this is speculative, further research regarding the barriers to CPR training in Egypt is needed.…”

Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status

“…They may also communicate more effectively with the dispatcher, which may explain the shorter response times seen in this study. A recent study revealed that highly educated individuals were more likely to be currently trained in CPR,22 which is likely to result in higher quality resuscitation. Another study has however found a negative association between education and odds of receiving bystander CPR,23 which may indicate that there is regional variation in this relationship.…”

The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities

“…Improving bystander interventions in these neighbourhoods may improve cardiac arrest survival. In a cross-sectional telephone survey, lesser education and lower income were associated with reduced likelihood of CPR training, illustrating the need to develop tailored CPR education to address this variability [23]. Language barriers for comprehension and implementation of telephone-CPR were also identified.…”