CPR Less Likely for Black, Hispanic People

CPR was less likely for witnessed cardiac arrest when the victim was Black or Hispanic, even in the home and when accounting for neighborhood characteristics, according to a U.S. registry providing the most nuanced view yet.

Bystander CPR was a relative 26% less likely for Black and Hispanic persons than for white persons at home and 37% less likely in public locations, reported Paul S. Chan, MD, of Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and colleagues in the New England Journal of Medicine.

Rates of CPR were 38.5% for Black and Hispanic people versus 47.4% for whites at home (adjusted OR 0.74, 95% CI 0.72-0.76) and 45.6% versus 60.0% in public (aOR 0.63, 95% CI 0.60-0.66).

These differences were also seen in majority Black or Hispanic neighborhoods at home (aOR 0.79, 95% CI 0.75-0.83) and in public locations (aOR 0.63, 95% CI 0.59-0.68) and in neighborhoods without a predominant racial composition both at home (aOR 0.78, 95% CI 0.74-0.81) and in public locations (aOR 0.73, 95% CI 0.68-0.77).

As to the reasons for these differences, the researchers noted that Black and Hispanic communities receive less CPR training and have less ready access to dispatcher-assistance for bystander CPR, which they noted was possibly the consequence of structural racism leading to unequal investments.

Chan and team called the need for offering low-cost or no-cost CPR training in Black and Hispanic communities “critical,” adding that it should be linguistically appropriate and culturally sensitive.

However, they pointed out their “findings suggest that multifaceted public health interventions that go beyond CPR training may be needed to reduce racial and ethnic differences in bystander CPR.”

For example, “prioritizing funding for dispatcher-assisted CPR (including in Spanish and African languages) in majority Black and Hispanic neighborhoods and low-income neighborhoods can increase the incidence of bystander CPR in those vulnerable communities,” Chan and colleagues noted.

Also, “engaging community leaders is critical to address delays in the activation of 911 calls and issues of residents’ trust in institutions of authority,” they added.

Revamping CPR training videos, manikins, and other materials to portray persons with cardiac arrest and bystanders as a diverse, multicultural population merits study too, they suggested.

“The overall incidence of bystander CPR for witnessed out-of-hospital cardiac arrest in this study is disappointing,” wrote Walter K. Clair, MD, MPH, of Vanderbilt University Medical Center in Nashville, in an accompanying editorial.

Parity at these low levels isn’t enough, he argued.

“We need to use what we learn about disparities to help improve the likelihood of bystander CPR for everyone,” Clair concluded. “This study reminds us that our efforts to decrease cardiovascular morbidity may be complicated to some extent by a legacy of structural racism that has left many of our communities segregated and with inequitable social determinants of sudden cardiac death.”

The study utilized the Cardiac Arrest Registry to Enhance Survival (CARES), with data on all 460,827 persons with a nontraumatic out-of-hospital cardiac arrest in the catchment area representing 51% of the U.S. population.

After excluding pediatric and arrests without an opportunity for bystander CPR due to being unwitnessed or witnessed by emergency medical personnel or at a healthcare facility, the analysis included 110,054 cardiac arrests among Black, Hispanic, or white individuals that were reported by 1,614 EMS agencies.

The location of the cardiac arrest was at home for 76.6% and in a public location for 23.4%.

Accounting for differences in the incidence of bystander CPR attenuated the racial and ethnic differences in cardiac arrest survival — for example, from an adjusted OR of 0.77 to 0.88 in events that occurred at home.

The patterns of association were similar for cardiac arrests that occurred at home and those in public locations when analyzed according to neighborhood income and when the analyses separated Black and Hispanic persons.

The lower likelihood of bystander CPR for Black and Hispanic individuals compared with white individuals held across every public location category:

• Workplace (53.2% vs 61.8%, aOR 0.73, 95% CI 0.70-0.77)
• Recreational facilities (55.8% vs 74.4%, aOR 0.50, 95% CI 0.43-0.56)
• Public transportation centers (48.3% vs 69.6%, aOR 0.46, 95% CI 0.37-0.57)

Limitations of the study included lack of data on the race of bystanders (which would be informative on bias), the number of potential laypersons witnessing the arrest, or what reasons bystanders’ would have given for not providing CPR.

“Since this study was conducted with data from persons with witnessed arrests, future efforts to collect bystander information would provide critical insights with regard to which public health interventions may have the largest effect in reducing differences in the incidence of bystander CPR,” Chan and colleagues noted.