Need CPR? Whether you get it may depend on the neighborhood
If your heart stops and you fall to the ground, your chances of survival may depend on which neighborhood you’re in when you collapse.
Patients suffering cardiac arrest in poorer, predominantly black neighborhoods were half as likely to receive CPR from a bystander as those in richer, predominantly white neighborhoods, according to research published in Thursday’s edition of the New England Journal of Medicine.
Even cardiac arrest victims in well-to-do black neighborhoods were 23% less likely to receive bystander assistance. And overall, blacks and Latinos were less likely to receive aid, regardless of where they were.
“We’ve started to look into how neighborhoods affect people’s health for obesity and food deserts and cancer, but this is the first time we’ve really thought about it for cardiac arrest,” said Dr. Comilla Sasson, an emergency medicine physician at the University of Colorado School of Medicine in Aurora, who led the study.
Sudden cardiac arrest outside a hospital setting is the leading cause of death in the United States, killing some 300,000 people annually. Sudden cardiac arrest is caused by an electrical glitch that prompts an abnormal heart rhythm and is different from a heart attack, which happens when blood flow is blocked and a region of the heart is starved of oxygen. About 92% of people who suffer sudden cardiac arrest die.
This is where CPR comes in. Those first few minutes after a person’s heart malfunctions, but before an ambulance arrives and emergency medical responders take over, can mean all the difference for survival.
But survival rates vary widely from city to city. In places like Seattle, the rate is 16%. In Detroit, it’s 0.2%.
It’s unclear exactly why these differences exist. Seattle is thought to have a widespread culture of CPR training, Sasson said, and it’s somewhat whiter and more well-to-do than long-suffering Detroit. Studies in Canada and Seattle have indicated that economics are key, with victims faring better in richer areas than in poorer ones. But studies conducted in Chicago in the 1980s found that race was a major factor.
The researchers behind the new analysis suspected that both issues were in play. They culled data from 29 cities and counties covering some 22 million people, using data from the Cardiac Arrest Registry to Enhance Survival, which is maintained by the Centers for Disease Control and Prevention.
Sasson and her colleagues examined 14,225 cases of sudden cardiac arrest from October 2005 through December 2009 and used census-tract data to sort the victims according to where they had their attack. The categories included neighborhoods that were “rich” (with a median income of $40,000 or more) or “poor” (below $40,000), as well as those that were more than 80% black, more than 80% white or integrated.
The researchers found that, overall, 28.6% of people received CPR from a bystander. But their particular odds of receiving help depended greatly on where they were.
Compared with victims in high-income, predominantly white neighborhoods, those in low-income, predominantly black neighborhoods were 51% less likely to receive CPR, and those in poor white neighborhoods were 35% less likely to receive CPR, the team calculated.
Even those who collapsed in rich black neighborhoods were 23% less likely than their peers in rich white neighborhoods to receive CPR from a bystander. There was no significant difference in CPR rates for victims in rich integrated neighborhoods compared with those in rich white neighborhoods.
Add this to the fact that some of the communities with a very high risk of sudden cardiac arrest are also among those least likely to provide bystander CPR and you’ve got a prescription for some very concerned cardiologists.
But the study also found that, overall, blacks and Latinos were about 30% less likely than whites to receive CPR from a bystander no matter where they were when they fell ill.
Why? “That’s sort of a sociologist’s question,” said Dr. Robert Berg, chief of critical care medicine at the Children’s Hospital of Philadelphia. “As a physician that’s involved in cardiac arrest and resuscitation, that’s disappointing to me.”
For their part, the medical professionals focus on the aspects they can address.
Part of the reason for the discrepancy in CPR rates has to do with cost, said Dr. Gordon Ewy, director of the University of Arizona Sarver Heart Center in Tucson.
“If you are struggling to make ends meet, you don’t have time to spend $45 and several hours ‘getting certified,’” said Ewy, who was not involved in the study.
And for many, Sasson said, the perceived crime risk in low income, minority neighborhoods keeps them from going out in the street to help someone who has collapsed.
That’s in part why emergency medical physicians and cardiologists are promoting a new, simpler type of CPR. It requires no mouth-to-mouth resuscitation, only that a bystander perform at least 100 chest compressions per minute, to the beat of — yes — the Bee Gee’s disco-era hit “Stayin’ Alive.”
The hope is that people will be more willing to perform this kind of CPR, and more confident too. It requires no certification; viewers can learn the technique by watching videos on YouTube.
“It’s now up to us in the medical community and the public health community to take that data and to shift our way of looking at how we deliver CPR education,” Sasson said.
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