In the Journals

CPR use, survival rates low after cardiac arrest in black neighborhoods

Raina M. Merchant

Adults with out-of-hospital cardiac arrest were less likely to receive bystander treatment and had lower survival if the event occurred in a predominately black neighborhood, according to published findings.

 

“Out-of-hospital cardiac arrest survival rate is 8.3% to 10% annually; however, there is regional variation in the incidence of and survival from OHCA,” Monique Anderson Starks, MD, MHS, of the Duke Clinical Research Institute, and colleagues wrote. “The incidence of OHCA has been consistently higher in black individuals compared with white individuals in the United States. Notable disparities exist in CPR training and the use of bystander CPR in predominantly black vs. white communities.”

Starks and colleagues collected data on out-of-hospital cardiac arrest (OHCA) from the Resuscitation Outcomes Consortium from 2008 to 2011. Neighborhoods were classified by census tract based on percentage of black residents (< 25%, 25% to 50%, 51% to 75% or > 75%).

Of the 22,816 adults included in the study (mean age, 64 years), those in neighborhoods with more than 75% black residents were slightly younger, more frequently women, had lower rates of initial shockable rhythm and less frequently experienced OHCA in a public location compared with those in neighborhoods with a lower proportion of black residents. There was similar mortality between white and black participants in the same neighborhood racial quantile.

Individuals with OHCA in a neighborhood with a higher proportion of black residents were less likely to receive bystander CPR or a lay automatic external defibrillation.

After adjustment for patient, neighborhood and treatment characteristics, participants living in mixed to majority black neighborhoods had decreased survival vs. those living in neighborhoods with less than 25% black residents (OR for 25% to 50% black neighborhoods = 0.76; 95% CI, 0.61-0.93; OR for 50% to 75% black neighborhoods = 0.67; 95% CI, 0.49-0.9; OR for > 75% black neighborhoods = 0.63; 95% CI, 0.5-0.79).

“Bystander treatments and survival after OHCA are significantly lower in neighborhoods with a higher percentage of black residents,” the researchers wrote. “Novel education and implementation efforts are needed to improve resuscitation outcomes in these neighborhoods.”

In an accompanying editorial, Raina M. Merchant, MD, MSHP, and Peter W. Groeneveld, MD, MS, both of the University of Pennsylvania, highlighted the role that social media and technologies like mobile phones can have in addressing this gap in care, as access to these digital tools is increasing across socioeconomic groups, ages and geographic regions.

“The presence of personalized technology and online networks does not inevitability translate into their use in health emergencies, but it offers the promise of reaching diverse populations in ways that conventional public health initiatives have not,” Merchant and Groeneveld wrote. “These tools can engage people outside of traditional health care environments and use the everyday tools used on a daily basis to access food, housing, leisure and other social services.” – by Cassie Homer

Disclosures: The authors and Merchant report no relevant financial disclosures. Groeneveld reports he is an employee of the U.S. government.

Raina M. Merchant

Adults with out-of-hospital cardiac arrest were less likely to receive bystander treatment and had lower survival if the event occurred in a predominately black neighborhood, according to published findings.

 

“Out-of-hospital cardiac arrest survival rate is 8.3% to 10% annually; however, there is regional variation in the incidence of and survival from OHCA,” Monique Anderson Starks, MD, MHS, of the Duke Clinical Research Institute, and colleagues wrote. “The incidence of OHCA has been consistently higher in black individuals compared with white individuals in the United States. Notable disparities exist in CPR training and the use of bystander CPR in predominantly black vs. white communities.”

Starks and colleagues collected data on out-of-hospital cardiac arrest (OHCA) from the Resuscitation Outcomes Consortium from 2008 to 2011. Neighborhoods were classified by census tract based on percentage of black residents (< 25%, 25% to 50%, 51% to 75% or > 75%).

Of the 22,816 adults included in the study (mean age, 64 years), those in neighborhoods with more than 75% black residents were slightly younger, more frequently women, had lower rates of initial shockable rhythm and less frequently experienced OHCA in a public location compared with those in neighborhoods with a lower proportion of black residents. There was similar mortality between white and black participants in the same neighborhood racial quantile.

Individuals with OHCA in a neighborhood with a higher proportion of black residents were less likely to receive bystander CPR or a lay automatic external defibrillation.

After adjustment for patient, neighborhood and treatment characteristics, participants living in mixed to majority black neighborhoods had decreased survival vs. those living in neighborhoods with less than 25% black residents (OR for 25% to 50% black neighborhoods = 0.76; 95% CI, 0.61-0.93; OR for 50% to 75% black neighborhoods = 0.67; 95% CI, 0.49-0.9; OR for > 75% black neighborhoods = 0.63; 95% CI, 0.5-0.79).

“Bystander treatments and survival after OHCA are significantly lower in neighborhoods with a higher percentage of black residents,” the researchers wrote. “Novel education and implementation efforts are needed to improve resuscitation outcomes in these neighborhoods.”

In an accompanying editorial, Raina M. Merchant, MD, MSHP, and Peter W. Groeneveld, MD, MS, both of the University of Pennsylvania, highlighted the role that social media and technologies like mobile phones can have in addressing this gap in care, as access to these digital tools is increasing across socioeconomic groups, ages and geographic regions.

“The presence of personalized technology and online networks does not inevitability translate into their use in health emergencies, but it offers the promise of reaching diverse populations in ways that conventional public health initiatives have not,” Merchant and Groeneveld wrote. “These tools can engage people outside of traditional health care environments and use the everyday tools used on a daily basis to access food, housing, leisure and other social services.” – by Cassie Homer

Disclosures: The authors and Merchant report no relevant financial disclosures. Groeneveld reports he is an employee of the U.S. government.