Association of Neighborhood Characteristics With Bystander-Initiated CPR

Oct 24, 2012
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Authors:
Sasson C, Magid DJ, Chan P, et al., on behalf of the CARES Surveillance Group.
Citation:
N Engl J Med 2012;367:1607-1615.
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

What is the impact of neighborhood characteristics in terms of predominant race and income level on the probability of receiving bystander-initiated cardiopulmonary resuscitation (CPR)?

Methods:

This was a multicenter cohort study of 14,225 patients with an out-of-hospital cardiac arrest. Low-income and high-income neighborhoods were those in which the median household income was less than $40,000 and $40,000 or more, respectively. Neighborhoods were classified as predominantly white (>80% white), predominantly black (>80% black), or integrated if there was no predominant racial composition. The relationships between median income and racial composition of a neighborhood and the performance of bystander-initiated CPR, the primary outcome, were analyzed.

Results:

Only 28.6% (n = 4,068) of patients received bystander-initiated CPR. Compared with patients experiencing cardiac arrest in high-income white neighborhoods, patients were less likely to receive bystander-initiated CPR in low-income, predominantly black neighborhoods (odds ratio, 0.49; 95% confidence interval [CI], 0.41-0.58). Individually, patients who were black or Hispanic were less likely to receive bystander-initiated CPR than those who were white, with odds ratios of 0.78 (95% CI, 0.70-0.87) and 0.73 (95% CI, 0.61-0.87), respectively.

Conclusions:

The odds of receiving bystander-initiated CPR for out-of-hospital cardiac arrest in low-income, predominantly black neighborhoods were dramatically lower than in high-income, predominantly white neighborhoods.

Perspective:

The authors demonstrated a disturbing and direct relationship between the median income and racial composition of neighborhood and the probability of receiving bystander-initiated CPR. Furthermore, less than one-third of all patients received bystander-initiated CPR. Individually, black and Hispanic patients were 30% less likely than white patients to receive bystander-initiated CPR. These gaping disparities are a call to action and an opportunity to understand the barriers to CPR performance, broaden the reach of CPR, and perhaps focus outreach efforts on particularly high-risk neighborhoods.

Keywords: Out-of-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation, Hispanic Americans


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