Race and income impacts rate of bystander-initiated CPR in communities

Oct 30 2012

By Andrew Czyzewski, medwireNews Reporter

medwireNews: Individuals who have an out-of-hospital cardiac arrest are most likely to receive bystander-initiated cardiopulmonary resuscitation (CPR) if they live in a predominantly White, high-income neighborhood, study results show.

Indeed, by comparison with this group, people in low-income, predominantly Black neighborhoods were around 50% less likely to receive bystander-initiated CPR.

Comilla Sasson (University of Colorado School of Medicine, Denver, USA) and colleagues therefore say that CPR training targeted to these neighborhoods "may constitute an evidence-based approach to public health planning."

The researchers analyzed data from 29 US sites prospectively submitted to the Cardiac Arrest Registry to Enhance Survival between October 2005 and December 2009.

They classified neighborhoods as high-income or low-income on the basis of a median household income threshold of US$ 40,000 (€ 31,017) 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.

From a total of 14,225 patients who had an out-of-hospital cardiac arrest, 4068 (28.6%) received bystander-initiated CPR.

However, there were clear differences between different racial and economic groups. For example, the rate of bystander-initiated CPR was just 18% in low-income, predominantly Black neighbourhoods, compared with 37% in high-income, predominantly White neighborhoods.

Sasson et al therefore performed multivariable predictive analysis using high-income White neighborhoods as a reference group.

They found that patients who had a cardiac arrest in low-income Black neighborhoods were significantly less likely to receive bystander-initiated CPR (odds ratio [OR]=0.49), as were patients in neighborhoods characterized as low-income White (OR=0.65), low-income integrated (OR=0.62), and high-income Black (OR=0.77).

People in high-income integrated neighborhoods had a similar likelihood of receiving bystander-initiated CPR as those in high-income White neighborhoods (OR=1.03).

Discussing the findings, Sasson et al note that, independent of the neighborhood in which the cardiac arrest occurs, Blacks and Hispanics were approximately 30% less likely than Whites to receive bystander-initiated CPR.

Although they did not have sufficient data to examine this independently in the predictive model, it does suggest that "neighborhood effects, although important, do not fully account for observed racial differences," Sasson et al conclude.

The research is published in the New England Journal of Medicine.

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