Racial and ethnic differences in bystander CPR for witnessed cardiac arrest
Open accessAbstract
BACKGROUND: Differences in the incidence of cardiopulmonary resuscitation (CPR) provided by bystanders contribute to survival disparities among persons with out-of-hospital cardiac arrest. It is critical to understand whether the incidence of bystander CPR in witnessed out-of-hospital cardiac arrests at home and in public settings differs according to the race or ethnic group of the person with cardiac arrest in order to inform interventions. METHODS: Within a large U.S. registry, we identified 110,054 witnessed out-of-hospital cardiac arrests during the period from 2013 through 2019. We used a hierarchical logistic regression model to analyze the incidence of bystander CPR in Black or Hispanic persons as compared with White persons with witnessed cardiac arrests at home and in public locations. We analyzed the overall incidence as well as the incidence according to neighborhood racial or ethnic makeup and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black or Hispanic (>50% of residents), or integrated, and as high income (an annual median household income of >$80,000), middle income ($40,000-$80,000), or low income (<$40,000). RESULTS: Overall, 35,469 of the witnessed out-of-hospital cardiac arrests (32.2%) occurred in Black or Hispanic persons. Black and Hispanic persons were less likely to receive bystander CPR at home (38.5%) than White persons (47.4%) (adjusted odds ratio, 0.74; 95% confidence interval [CI], 0.72 to 0.76) and less likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%) (adjusted odds ratio, 0.63; 95% CI, 0.60 to 0.66). The incidence of bystander CPR among Black and Hispanic persons was less than that among White persons not only in predominantly White neighborhoods at home (adjusted odds ratio, 0.82; 95% CI, 0.74 to 0.90) and in public locations (adjusted odds ratio, 0.68; 95% CI, 0.60 to 0.75) but also in majority Black or Hispanic neighborhoods at home (adjusted odds ratio, 0.79; 95% CI, 0.75 to 0.83) and in public locations (adjusted odds ratio, 0.63; 95% CI, 0.59 to 0.68) and in integrated neighborhoods at home (adjusted odds ratio, 0.78; 95% CI, 0.74 to 0.81) and in public locations (adjusted odds ratio, 0.73; 95% CI, 0.68 to 0.77). Similarly, across all neighborhood income strata, the frequency of bystander CPR at home and in public locations was lower among Black and Hispanic persons with out-of-hospital cardiac arrest than among White persons. CONCLUSIONS: In witnessed out-of-hospital cardiac arrest, Black and Hispanic persons were less likely than White persons to receive potentially lifesaving bystander CPR at home and in public locations, regardless of the racial or ethnic makeup or income level of the neighborhood where the cardiac arrest occurred. (Funded by the National Heart, Lung, and Blood Institute.).
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An investigation of bystander CPR response for witnessed cardiac arrest found that Black and Hispanic patients or females are less likely to get CPR regardless of income level or neighborhood where the cardiac arrest occurred.
“An investigation of bystander CPR response for witnessed cardiac arrest found that Black and Hispanic patients or females are less likely to get CPR regardless of income level or neighborhood where the cardiac arrest occurred. 34”
From AI pitfalls and what not to do: mitigating bias in AI (2023) · cites this paper as [34]
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Adverse Effects After Prehospital Administration of Naloxone by Bystanders: A Preliminary Study
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Disentangling the Complex Web of Out-of-Hospital Cardiac Arrest Socioeconomic Disparities
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- Authors
- Garcia, R. A., Spertus, J. A., Girotra, S., Nallamothu, B. K., Kennedy, K. F., McNally, B. F., Breathett, K., Del Rios, M., Sasson, C., & Chan, P. S.
- Affiliations
- University of Iowa (US)
- From Saint Luke’s Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) — both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) — both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.).
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2022-10-27
- Volume
- 387
- Issue
- 17
- Pages
- 1569-1578
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC9760357
- OpenAlex
- W4307564569
- Cited by
- 163
- References
- 28
- Citations by year
- 2026: 30 · 2025: 46 · 2024: 43 · 2023: 42 · 2022: 2
- FWCI
- 36.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (5T32H110837, K01HL142848, R56HL159216, and L30HL148881, R01HL160734)
- American Heart Association (N/A)
- American Red Cross (N/A)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- bystander CPR, out-of-hospital cardiac arrest, racial disparities, ethnic disparities, Black patients, Hispanic patients, neighborhood racial composition, neighborhood income, survival disparities, bystander CPR training
- MeSH terms
- Race Factors, Black or African American, Emergency Medical Services, Hispanic or Latino, Humans, Income, Registries, Residence Characteristics, United States, Incidence, Cardiopulmonary Resuscitation, Black People, White People, Out-of-Hospital Cardiac Arrest
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