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Race, income level may affect odds of getting CPR

Thursday October 25, 2012
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People who suffer cardiac arrests in upper income, white neighborhoods are significantly more likely to get cardiopulmonary resuscitation than those who collapse in low-income, black neighborhoods, according to a study.

People in a neighborhood that is 80% white with a median annual income of more than $40,000 have a 55% chance of getting CPR after a cardiac arrest, said Comilla Sasson, MD, a study author and ED physician at the University of Colorado Hospital. Those in need in poor, black neighborhoods have a 35% chance.

"Life or death can literally be determined by what side of the street you drop in," Sasson said in a news release.

Sasson, an assistant professor in the Department of Emergency Medicine at the University of Colorado School of Medicine, analyzed data from 14,225 patients who suffered cardiac arrests in 29 cities from 2005 through 2009. She and her colleagues used census data to determine which neighborhood the event took place in, its racial make-up and median household income. Low-income was considered at or below $40,000 a year.

A number of reasons were identified for this disparity. One is the cost of CPR training. Another is a lack of outreach to minority neighborhoods by organizations that promote CPR. There also are language barriers and cultural issues surrounding the learning and performance of CPR.

Part of the study involved conducting focus groups in poor neighborhoods. In one area of Columbus, Ohio, residents had median incomes of $20,000.

"If they paid $250 for a CPR class, you are talking about 15% of their salary," Sasson said. "When you look at the competing economic interests — am I going to eat tonight or attend a CPR class? — the answer is obvious."

According to the study, there are 300,000 out-of-hospital cardiac arrests each year with survival rates that vary from 0.2% in Detroit to 16% in Seattle. The difference can be explained in large part to intervention with CPR.

"For every 20 who get CPR you get one life saved," Sasson said. "So you are talking about thousands of lives being saved here."

Even in wealthier black neighborhoods, those who had cardiac arrest were 23% less likely to receive CPR than in high-income non-black neighborhoods. The researchers also found that regardless of the neighborhood where a cardiac arrest occurs, blacks and Hispanics were 30% less likely than whites to receive CPR from a bystander.

"This suggests that neighborhood effects, though important, do not fully account for observed racial differences," the authors wrote.

Sasson called for more targeted, low-cost CPR training efforts based on the income and racial composition of neighborhoods. She also is working to create public health programs aimed at increasing bystander-given CPR in specific communities.

As a physician who once practiced in a level one trauma center in Atlanta, Sasson has witnessed the human toll of this inequity.

"I would see African-Americans coming in and dying from cardiac arrests after having laid there for 10 minutes with no one delivering CPR," she said. "There is no reason in 2012 that this kind of disparity exists. It is simply unacceptable."

The study appears in the Oct. 25 issue of the New England Journal of Medicine. The study abstract is available at www.nejm.org/doi/full/10.1056/NEJMoa1110700.


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