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25 October 2012

People more likely to do CPR in wealthier areas

People in wealthier white or integrated neighbourhoods are more likely to try to save a cardiac arrest victim using CPR than people in other neighbourhoods.

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People in wealthier white or integrated neighbourhoods are more likely to try to save a cardiac arrest victim using CPR than people in other neighbourhoods, according to a large US study funded by the Centers for Disease Control and Prevention.

"Where you drop literally can determine your likelihood of having someone stop and do CPR, and it changes from one side of the street to the other," said co-author Dr Comilla Sasson of the University of Colorado School of Medicine.

Although the racial makeup of a neighbourhood was a factor, "it's probably socioeconomic status that matters more than racial composition," she said.

About 300 000 people collapse from cardiac arrest each year, and other research has suggested that ethnic or socioeconomic conditions influence the chance that a bystander will start CPR.

"We've seen for many years that certain communities have a higher likelihood of a patient getting CPR," said Dr Bryan McNally of Emory University in Atlanta, another co-author. "This is pointing out that within communities there is variation in the local or neighbourhood area."

How the research was done

The findings, reported online in the New England Journal of Medicine, are based on 14 225 cases of cardiac arrest from 29 non-rural parts of the US.

Using Census data, the researchers separated the sites of each collapse into two categories: high income, where the median household income was $40 000 or more, and low income. A neighbourhood was given an ethnic classification if that group made up more than 80% of the population.

The overall chance of a cardiac arrest victim getting CPR from a bystander was about 29%.

Understanding CPR barriers

Based on the results, if a bystander is available to help and "a person who falls down in a primarily-white higher-income neighbourhood, their chance of getting CPR is 55%," said Dr Sasson.

In a high-income integrated neighbourhood, the chance was 49%. It was 45% in a high-income black neighbourhood.

"If that person crosses the street and goes into an African-American poor neighbourhood, the percentage goes down to 35%," Dr Sasson said.

She said information from focus groups suggests that one reason the rate may be lower in poorer neighbourhoods is the cost of CPR training, which can be up to $250 for a class. "If you're making $20 000 a year, that's 15% of your monthly income. A lot of folks would love to learn it, but they can't."

"Once the barriers to CPR training and performance are better understood, it may be possible to design more linguistically appropriate and culturally sensitive CPR training programmes that can be implemented in neighbourhoods with low rates of bystander-initiated CPR," the team said.

The study "may help guide decision making about where to put our resources," Dr McNally said. The study did not examine if a neighbourhood’s characteristics affected a person's chance of surviving cardiac arrest.

In this study, only 8% of the patients survived to be discharged from the hospital, and about half of those had some kind of brain damage.

(Reuters Health, October 2012)

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