Racial and ethnic disparities in the provision of bystander CPR after witnessed out-of-hospital cardiac arrest in the United States

Jake Toy; Nichole Bosson; Shira Schlesinger; Marianne Gausche-Hill

doi:10.1016/j.resuscitation.2023.109901

Racial and ethnic disparities in the provision of bystander CPR after witnessed out-of-hospital cardiac arrest in the United States

Resuscitation. 2023 Sep:190:109901. doi: 10.1016/j.resuscitation.2023.109901. Epub 2023 Jul 12.

Authors

Jake Toy¹, Nichole Bosson², Shira Schlesinger³, Marianne Gausche-Hill²

Affiliations

¹ University of California Los Angeles, Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095, USA; Harbor-UCLA Medical Center, Department of Emergency Medicine & The Lundquist Institute, 1000 W Carson Street, Torrance, CA 90502, USA; Los Angeles County EMS Agency, 10100 Pioneer Blvd, Santa Fe Springs, CA 90670, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA. Electronic address: jtoy2@dhs.lacounty.gov.
² Harbor-UCLA Medical Center, Department of Emergency Medicine & The Lundquist Institute, 1000 W Carson Street, Torrance, CA 90502, USA; Los Angeles County EMS Agency, 10100 Pioneer Blvd, Santa Fe Springs, CA 90670, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
³ Harbor-UCLA Medical Center, Department of Emergency Medicine & The Lundquist Institute, 1000 W Carson Street, Torrance, CA 90502, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.

PMID: 37442519
DOI: 10.1016/j.resuscitation.2023.109901

Abstract

Objective: To evaluate the association between race/ethnicity and the odds of receiving bystander cardiopulmonary resuscitation (bCPR) after witnessed out-of-hospital cardiac arrest (OHCA).

Methods: For this cross-sectional retrospective study, data were obtained from the National Emergency Medical Services Information System database for adults (≥18 years) with a witnessed non-traumatic OHCA in the year 2021. Patients were separated into two groups including Black/Hispanic and White. The primary outcome was the odds of receiving bCPR. We excluded traumatic etiology, do-not-resuscitate orders, and arrest in a healthcare facility or wilderness location. Multiple logistic regression controlling for known covariates was utilized and analyses were stratified by public versus non-public location, median household income, and rural, suburban, or urban setting.

Results: A total of 64,007 witnessed OHCAs were included. When compared to White, the Black/Hispanic group were younger (62 vs 67 years) and more often female (40% vs 33%), in neighborhoods with the lowest median household income (31% vs 13%) and in an urban setting (92% vs 80%). Overall, bystander CPR rates were 60% and 67% for the Black/Hispanic and White groups, respectively. Multiple logistic regression stratified by OHCA location found that the Black/Hispanic group had a decreased odds of receiving bCPR compared to the White group both in the home (adjusted OR [aOR] 0.77; 95% CI 0.74-0.81) and in public (aOR 0.69; 95% CI 0.64-0.76). This difference persisted throughout neighborhoods of different socioeconomic status and across the rural-urban spectrum.

Conclusions: Racial/ethnic disparities exist for Black and Hispanic persons in the odds of receiving bCPR after a witnessed non-traumatic OHCA regardless of public or private setting, neighborhood income level, or population density.

Keywords: Bystander cardiopulmonary resuscitation; Out-of-hospital cardiac arrest; Racial disparities.

MeSH terms

Adult
Cardiopulmonary Resuscitation*
Cross-Sectional Studies
Emergency Medical Services*
Ethnicity
Female
Humans
Out-of-Hospital Cardiac Arrest* / epidemiology
Out-of-Hospital Cardiac Arrest* / therapy
Retrospective Studies
United States / epidemiology