Background

Differences in the incidence of cardiopulmonary resuscitation (CPR) provided by bystanders contribute to survival disparities among persons with out-of-hospital cardiac arrest. It is critical to understand whether the incidence of bystander CPR in witnessed out-of-hospital cardiac arrests at home and in public settings differs according to the race or ethnic group of the person with cardiac arrest in order to inform interventions.

Methods

Within a large U.S. registry, we identified 110,054 witnessed out-of-hospital cardiac arrests during the period from 2013 through 2019. We used a hierarchical logistic regression model to analyze the incidence of bystander CPR in Black or Hispanic persons as compared with White persons with witnessed cardiac arrests at home and in public locations. We analyzed the overall incidence as well as the incidence according to neighborhood racial or ethnic makeup and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black or Hispanic (>50% of residents), or integrated, and as high income (an annual median household income of >$80,000), middle income ($40,000–$80,000), or low income (<$40,000).

Results

Overall, 35,469 of the witnessed out-of-hospital cardiac arrests (32.2%) occurred in Black or Hispanic persons. Black and Hispanic persons were less likely to receive bystander CPR at home (38.5%) than White persons (47.4%) (adjusted odds ratio, 0.74; 95% confidence interval [CI], 0.72 to 0.76) and less likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%) (adjusted odds ratio, 0.63; 95% CI, 0.60 to 0.66). The incidence of bystander CPR among Black and Hispanic persons was less than that among White persons not only in predominantly White neighborhoods at home (adjusted odds ratio, 0.82; 95% CI, 0.74 to 0.90) and in public locations (adjusted odds ratio, 0.68; 95% CI, 0.60 to 0.75) but also in majority Black or Hispanic neighborhoods at home (adjusted odds ratio, 0.79; 95% CI, 0.75 to 0.83) and in public locations (adjusted odds ratio, 0.63; 95% CI, 0.59 to 0.68) and in integrated neighborhoods at home (adjusted odds ratio, 0.78; 95% CI, 0.74 to 0.81) and in public locations (adjusted odds ratio, 0.73; 95% CI, 0.68 to 0.77). Similarly, across all neighborhood income strata, the frequency of bystander CPR at home and in public locations was lower among Black and Hispanic persons with out-of-hospital cardiac arrest than among White persons.

Conclusions

In witnessed out-of-hospital cardiac arrest, Black and Hispanic persons were less likely than White persons to receive potentially lifesaving bystander CPR at home and in public locations, regardless of the racial or ethnic makeup or income level of the neighborhood where the cardiac arrest occurred. (Funded by the National Heart, Lung, and Blood Institute.)

中文翻译：

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目击心脏骤停旁观者 CPR 的种族和民族差异

背景

旁观者提供的心肺复苏 (CPR) 发生率的差异导致院外心脏骤停患者的生存差异。了解在家中和公共场所目击的院外心脏骤停中旁观者 CPR 的发生率是否因心脏骤停患者的种族或族裔群体而异，以便为干预提供信息，这一点至关重要。

方法

在美国的一个大型登记处，我们确定了 2013 年至 2019 年期间有 110,054 名目击者院外心脏骤停。我们使用分层逻辑回归模型来分析黑人或西班牙裔人与有心脏病的白人相比，旁观者 CPR 的发生率在家里和公共场所目睹心脏骤停。我们分析了总体发病率以及根据邻里种族或民族构成和收入阶层的发病率。社区被分类为以白人为主（>80% 的居民）、以黑人或西班牙裔为主（>50% 的居民）或综合社区，以及高收入（家庭年收入中位数 >80,000 美元）、中等收入（40,000 美元至 80,000 美元） )，或低收入（<40,000 美元）。

结果

总体而言，目击的院外心脏骤停事件中有 35,469 例 (32.2%) 发生在黑人或西班牙裔人身上。与白人 (47.4%) 相比，黑人和西班牙裔在家接受旁观者 CPR 的可能性 (38.5%) 较低（调整后的比值比为 0.74；95% 置信区间 [CI]，0.72 至 0.76）并且接受旁观者 CPR 的可能性较低在公共场所比白人多（45.6% 对 60.0%）（调整后的比值比，0.63；95% CI，0.60 至 0.66）。黑人和西班牙裔人中旁观者 CPR 的发生率低于白人，不仅是在家中以白人为主的社区（调整后的比值比为 0.82；95% CI，0.74 至 0.90）和公共场所（调整后的比值比为 0.68） ; 95% CI，0.60 至 0.75），但也存在于家中的大多数黑人或西班牙裔社区（调整后的比值比，0.79；95% CI，0.75 至 0. 83) 和在公共场所（调整后的比值比，0.63；95% CI，0.59 至 0.68）和在家中的综合社区（调整后的比值比，0.78；95% CI，0.74 至 0.81）和在公共场所（调整后的比值比, 0.73；95% CI，0.68 至 0.77）。同样，在所有社区收入阶层中，发生院外心脏骤停的黑人和西班牙裔人在家中和公共场所接受旁观者 CPR 的频率低于白人。

结论

在目击的院外心脏骤停中，黑人和西班牙裔人比白人更不可能在家中和公共场所接受可能挽救生命的旁观者心肺复苏术，无论心脏骤停发生地的种族或民族构成或收入水平如何发生。（由国家心肺血液研究所资助。）