Racial and Ethnic Differences in Bystander Cardiopulmonary Resuscitation for Witnessed Out-of-Hospital Cardiac Arrest
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Abstract
Differences in bystander cardiopulmonary resuscitation (CPR) contribute to survival disparities for witnessed out-of-hospital cardiac arrest (OHCA). Whether bystander CPR rates differ by race/ethnicity for witnessed OHCAs at home and in public settings is critical to understand for informing interventions. Within a large U.S. registry, 110,054 witnessed OHCAs were identified during 2013-2019. Using hierarchical logistic regression, the rates of bystander CPR were compared in Blacks/Hispanics vs. Whites for witnessed OHCAs at home and in public locations, overall and by neighborhood race/ethnicity and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black/Hispanic (>50%), or integrated, and as high- (annual median household income >$80,000), middle- ($40,000-$80,000), or low-income (<$40,000). Overall, 35,469 (32.2%) witnessed OHCAs occurred in Black/Hispanic individuals. Blacks/Hispanics were less likely to receive bystander CPR at home (38.5% vs. 47.4% for Whites; adjusted OR [aOR]=0.74 [95% CI: 0.71-0.76]) and in public (45.6% vs. 60.0%; aOR=0.59 [0.56-0.63]), and this difference was greater for OHCAs occurring in public (P for interaction <0.001). Rates of bystander CPR were lower in Blacks/Hispanics in majority Black/Hispanic (home: aOR=0.81 [0.76-0.86]; public: aOR=0.60 [0.54-0.66]), integrated (home: OR=0.79 [0.74-0.83]; public: OR=0.68 [0.62-0.74]), and predominantly White neighborhoods (home: OR=0.78 [0.69-0.88]; public: OR=0.61 [0.51-0.72]), and this difference was larger for OHCAs in public locations in each stratum (all P-values for interaction <0.02). A similar pattern for lower bystander CPR rates for Blacks/Hispanics vs. White for home and public OHCAs was found across neighborhood income strata. Black and Hispanic victims of witnessed OHCA are less likely to receive potentially life-saving bystander CPR, as compared with White patients, and this treatment difference was pervasive for witnessed OHCAs at home and in public, regardless of the neighborhood.
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Introduction -- Review of literature -- Methodology -- Results -- Discussion -- Appendix
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M.S. (Master of Science)