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Race and Sex Differences in Bystander CPR for Cardiac Arrest
Quick Takes
- Association between bystander CPR and survival was weaker for Black individuals and women with out-of-hospital cardiac arrest (OHCA) compared with White individuals and men.
- Furthermore, these differential associations between bystander CPR and survival were observed across neighborhood race and ethnicity and income strata.
- These data suggest that efforts to reduce survival disparities for OHCA may require not only increasing CPR training rates in undertreated communities but also ensuring that bystander CPR, when initiated, is delivered with comparable effectiveness in all individuals with OHCA.
Study Questions:
Is there a differential association between bystander cardiopulmonary resuscitation (CPR) and survival by sex and race and ethnicity of the patient with out-of-hospital cardiac arrest (OHCA)?
Methods:
The investigators identified 623,342 nontraumatic OHCAs during 2013 to 2022 within a large US registry for this observational cohort study. Using hierarchical logistic regression, the authors examined whether there was a differential association between bystander CPR and survival outcomes by patients’ sex and race and ethnicity, overall and by neighborhood strata.
Results:
The mean age was 62.1 ± 17.1 years, and 35.9% were women. Nearly half of patients (49.8%) were non-Hispanic White; 20.6% were non-Hispanic Black; 7.3% were Hispanic; 2.9% were Asian; and 0.4% were Native American. Overall, 58,098 (9.3%) survived to hospital discharge. Although bystander CPR was associated with higher survival in each race and ethnicity group, the association of bystander CPR compared with patients without bystander CPR in each racial and ethnic group was highest in individuals who were White (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.30-1.37) and Native American (aOR, 1.40; 95% CI, 1.02-1.90) and lowest in individuals who were Black (aOR, 1.09; 95% CI, 1.04-1.14; p for interaction < 0.001). The adjusted OR for bystander CPR compared with those without bystander CPR for Hispanic patients was 1.29 (95% CI, 1.20-1.139), for Asian patients, it was 1.27 (95% CI, 1.12-1.42), and for those of unknown race, it was 1.31 (95% CI, 1.25-1.36). Similarly, bystander CPR was associated with higher survival in both sexes, but its association with survival was higher in men (aOR, 1.35; 95% CI, 1.31-1.38) than women (aOR, 1.15; 95% CI, 1.12-1.19; p for interaction < 0.001). The weaker association of bystander CPR in Black individuals and women was consistent across neighborhood race and ethnicity and income strata. Similar results were observed for the outcome of survival without severe neurological deficits.
Conclusions:
The authors report that although bystander CPR was associated with higher survival in all patients, its association with survival was weakest for Black individuals and women with OHCA.
Perspective:
This registry study reports that association between bystander CPR and survival was weaker for Black individuals and women with OHCA compared with White individuals and men. Furthermore, these differential associations between bystander CPR and survival were observed across neighborhood race and ethnicity and income strata. These data suggest that efforts to reduce survival disparities for OHCA may require not only increasing CPR training rates in undertreated communities but also ensuring that bystander CPR, when initiated, is delivered with comparable effectiveness in all individuals with OHCA. Finally, additional studies are indicated to address disparities in bystander CPR care to ensure health care equity.
Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Acute Coronary Syndromes
Keywords: Cardiopulmonary Resuscitation, Healthcare Disparities, Out-of-Hospital Cardiac Arrest
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