Black, Hispanic individuals less likely to receive bystander CPR, no matter the setting

WASHINGTON — In a new study, bystander CPR for out-of-hospital cardiac arrest was performed less frequently for Black and Hispanic individuals compared with white individuals, irrespective of neighborhood demographics and income.

These disparities in bystander-initiated CPR for out-of-hospital cardiac arrest were consistent regardless of whether the event occurred at home or in a public setting such as the workplace or recreational facility, according to research presented at the American College of Cardiology Scientific Session.

“What is troubling is that the racial and ethnic difference in bystander CPR rates are greater for cardiac arrests occurring in public, regardless of neighborhood income or racial demographics,” Paul S. Chan, MD, professor of medicine at the University of Missouri–Kansas City School of Medicine and the Saint Luke’s Mid America Heart Institute, told Healio.

“Keep in mind, though, that these differences in bystander CPR treatment rates for cardiac arrests in public locations were pervasive, even in communities where more than 50% of residents were Black or Hispanic. If bias of any type — implicit or explicit — is a factor in our findings, it was not limited to white neighborhoods.”

Differences in bystander CPR rates

During a press conference, Chan explained that approximately 380,000 out-of-hospital cardiac arrests occur each year, with a survival rate of 8% to 10% or even less among Black and Hispanic individuals.

Initiation of bystander CPR can significantly improve the odds of survival in out-of-hospital cardiac arrest; therefore, researchers evaluated whether racial/ethnic disparities were present in bystander CPR. They also evaluated whether differences existed for patients with cardiac arrest at home or in public, and if in public did bystander CPR initiation differ by neighborhood demographics (eg, predominantly white, Black or integrated; and median household income).

“We had hypothesized that Black and Hispanic persons with cardiac arrest would have lower bystander CPR rates than white persons when these events occurred at home, but these differences would be smaller when they occurred in public,” Chan told Healio.

For the present analysis, researchers utilized data from the CARES registry and included data from 110,054 witnessed out-of-hospital cardiac arrests occurring between 2013 and 2019.

The odds of receiving bystander CPR were higher for white individuals experiencing out-of-hospital cardiac arrest compared with Black individuals (P for interaction < .001) both at home (38.5% vs. 47.4%; adjusted OR = 0.75; 95% CI, 0.72-0.78; P < .001) and in public (45.6% vs. 60%; aOR = 0.59; 95% CI, 0.56-0.63; P < .001). Public location, such as a workplace, street/highway, recreational facility, public transportation center or other public location, had no effect on the observed association between Black/Hispanic race and reduced odds of bystander CPR.

This observation remained consistent when researchers stratified neighborhood by predominant race:

• more than 80% white (aOR home = 0.8; 95% CI, 0.7-0.9; aOR public = 0.61; 95% CI, 0.52-0.73; P for interaction = .2);
• more than 50% Black and/or Hispanic (aOR home = 0.81; 95% CI, 0.77-0.86; aOR public = 0.6; 95% CI, 0.54-0.66; P for interaction < .001); and
• integrated neighborhoods (aOR home = 0.79; 95% CI, 0.74-0.83; aOR public = 0.68; 95% CI, 0.62-0.74; P for interaction = .004).

“This went against our hypothesis, where we expected this treatment difference for bystander CPR to be smaller for cardiac arrests occurring in public. And for both home and public cardiac arrests, we found the same patterns of lower rates of bystander CPR for Black and Hispanic individuals regardless of whether the community where the cardiac arrest occurred was predominantly White, majority Black or Hispanic or integrated, or whether the community was high, middle or low-income.”

In other findings, the likelihood of Black or Hispanic individuals experiencing out-of-hospital cardiac arrest to receive bystander CPR was lower compared with white individuals, irrespective a neighborhood’s median household income (P < .001).

Strategies to ‘narrow the gap’

“There has been a large push from national societies, such as the American Heart Association, to increase bystander CPR training in vulnerable communities,” Chan told Healio. “These efforts are laudable. However, I think our findings raise the question of whether this is enough to narrow the gap.

“We need to diversify our online, advertisement and training materials for CPR training. We need Black and Hispanic spokespersons to encourage Black and Hispanic individuals to learn CPR. We need Black and Hispanic mannequins and laypersons in online materials for CPR training,” Chan said. “We also need 9-1-1 dispatcher-assisted CPR available in vulnerable communities to instruct callers of an emergency to do CPR via telephone on the spot in Black and Hispanic communities.

And, we need low- or no-cost training of CPR in Black and Hispanic communities, and we need to do them in appropriate venues in these communities, whether they be in Black churches or Hispanic community centers. In short, we need to be intentional and creative to bridge the racial/ethnic gap for this easy to learn and potentially life-saving intervention.”