Variation in Bystander Cardiopulmonary Resuscitation Delivery and Subsequent Survival from Out-of-Hospital Cardiac Arrest Based on Neighborhood-Level Ethnic Characteristics

Audrey L. Blewer, Monique A. Starks, Robert H. Schmicker, Susanne May, Peter J. Kudenchuk, Laurie J. Morrison, Tom P. Aufderheide, Mohamud Daya, Ahamed H. Idris, Clifton W. Callaway, Gary M. Vilke, Benjamin S. Abella

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Bystander cardiopulmonary resuscitation (B-CPR) delivery and survival after out-of-hospital cardiac arrest vary at the neighborhood level, with lower survival seen in predominantly black neighborhoods. Although the Hispanic population is the fastest-growing minority population in the United States, few studies have assessed whether the proportion of Hispanic residents in a neighborhood is associated with B-CPR delivery and survival from out-of-hospital cardiac arrest. We assessed whether B-CPR rates and survival vary by neighborhood-level ethnicity. We hypothesized that neighborhoods with a higher proportion of Hispanic residents have lower B-CPR rates and lower survival. METHODS: We conducted a retrospective cohort study using data from the Resuscitation Outcomes Consortium Epistry at US sites. Neighborhoods were classified by census tract based on percentage of Hispanic residents: <25%, 25% to 50%, 51% to 75%, or >75%. We independently modeled the likelihood of receipt of B-CPR and survival by neighborhood-level ethnicity controlling for site and patient-level confounding characteristics. RESULTS: From 2011 to 2015, the Resuscitation Outcomes Consortium collected 27 481 US arrest events; after excluding pediatric arrests, emergency medical services-witnessed arrests, or arrests occurring in a healthcare or institutional facility, 18 927 were included. B-CPR was administered in 37% of events. In neighborhoods with <25% Hispanic residents, B-CPR was administered in 39% of events, whereas it was administered in 27% of events in neighborhoods with >75% Hispanic residents. Compared with <25% Hispanic neighborhoods in a multivariable analysis, out-of-hospital cardiac arrest in predominantly Hispanic neighborhoods had lower B-CPR rates (51% to 75% Hispanic: odds ratio, 0.79 [CI, 0.65-0.95], P=0.014; >75% Hispanic: odds ratio, 0.72 [CI, 0.55-0.96], P=0.025) and lower survival rates (global P value 0.029; >75% Hispanic: odds ratio, 0.56 [CI, 0.34-0.93], P=0.023). CONCLUSIONS: Individuals with out-of-hospital cardiac arrest in predominantly Hispanic neighborhoods were less likely to receive B-CPR and had lower likelihood of survival. These findings suggest a need to understand the underlying disparities in cardiopulmonary resuscitation delivery and an unmet cardiopulmonary resuscitation training need in Hispanic communities.

Original languageEnglish (US)
Pages (from-to)34-41
Number of pages8
JournalCirculation
DOIs
StatePublished - Jan 7 2020

Keywords

  • Hispanic Americans
  • cardiopulmonary resuscitation
  • out-of-hospital cardiac arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Blewer, A. L., Starks, M. A., Schmicker, R. H., May, S., Kudenchuk, P. J., Morrison, L. J., Aufderheide, T. P., Daya, M., Idris, A. H., Callaway, C. W., Vilke, G. M., & Abella, B. S. (2020). Variation in Bystander Cardiopulmonary Resuscitation Delivery and Subsequent Survival from Out-of-Hospital Cardiac Arrest Based on Neighborhood-Level Ethnic Characteristics. Circulation, 34-41. https://doi.org/10.1161/CIRCULATIONAHA.119.041541