Abstract Body: Background: Bystander CPR (bCPR) is associated with reduced mortality in out-of-hospital cardiac arrests (OHCA). Racial and ethnic disparities in bCPR have been reported, however the causes of these disparities are not well understood, particularly in the context of social drivers of health.
Hypothesis: We hypothesized that non-White persons would be less likely than White persons to receive bCPR when controlling for arrest location, neighborhood racial and ethnic composition, neighborhood income, and urbanicity in a large national prehospital dataset.
Goals: We sought to assess the relationship between race and bCPR, accounting for community socioeconomic and demographic factors
Methods: This retrospective analysis used cases gathered by ESO’s Data Collaborative, a US national repository of EMS records, from the years 2019 to 2023 for non-traumatic OHCA events prior to EMS arrival. Cases were excluded if a patient’s age or bCPR status was missing, if resuscitation was not attempted due to futility or DNR status, or if the arrest occurred in a healthcare location (e.g.: nursing homes, hospitals). We utilized a multivariable logistic regression model adjusting for age, race, gender, urbanicity, response time, arrest witness status, year of arrest, location (public vs. private), and social drivers of health as measured via the CDC Social Vulnerability Index for income and minority composition at the Census tract level.
Results: We screened a total of 55,435,888 cases gathered by ESO and analyzed a total of 305,175 OHCA cases. Of these, 66.4% of patients were White, 18.4% Black, 5.8% Hispanic, 1.8% Asian, 0.3% Pacific Islander, and 0.4% American Indigenous or Alaskan Native. The mean age was 59.9 +/- 20.0 years, and 35.9% were women. Overall, 30.4% of OHCAs received bCPR; bCPR rates varied across race (Black: 23.2%; White: 32.3%; Asian: 31.8%, Hispanic: 28.6%; Pacific Islander: 32.8%; American Indigenous: 27.9%). After adjustment Black persons (ORadj: 0.69, 95% CI: 0.67-0.70) and Hispanics (ORadj: 0.87 , 95% CI: 0.79-0.95) were less likely to receive bCPR than White persons. Asian persons (ORadj: 1.25, 95% CI: 1.13-1.38) appeared more likely than White persons to receive bCPR.
Conclusion: Irrespective of response characteristics, arrest characteristics, and neighborhood markers of social drivers of health, Black and Hispanic persons were less likely to receive bystander CPR compared to their White counterparts.