October 25, 2012
CPR Survival More Likely In Wealthy White Neighborhoods
Lawrence LeBlond for redOrbit.com - Your Universe Online
In a large, first-of-its-kind US study, conducted by the Centers for Disease Control and Prevention (CDC), it has been discovered that people who suffer cardiac arrest in poorer, predominantly black neighborhoods are half as likely to receive CPR from a bystander as those in richer, mostly white neighborhoods.
The study, published in Thursday´s edition of the New England Journal of Medicine (NEJM), shows that even in well-to-do black neighborhoods, cardiac arrest victims are 23 percent less likely to receive CPR from a bystander. The study also found that, overall, blacks and Latinos were less likely to receive aid, regardless of the neighborhood´s economic status.
Study author Comilla Sasson, MD, an emergency room physician at the University of Colorado Hospital said if a person has a heart attack “in a neighborhood that is 80 percent white with a median income over $40,000 a year, [that victim has] a 55 percent chance of getting CPR.” But in a predominantly black and poor neighborhood, the victim has only “a 35 percent chance.”
“Life or death can literally be determined by what side of the street you drop on,” said Sasson in a press release.
Although the racial card is a factor, Sasson believes “it´s socioeconomic status that matters more than racial composition” when it comes to saving a life.
Close to a third of a million people collapse from cardiac arrest each year in the US, and previous research has suggested that ethnic or socioeconomic conditions influence the chance that a bystander will perform CPR.
“We've seen for many years that certain communities have a higher likelihood of a patient getting CPR,” study coauthor Dr. Bryan McNally of Emory University in Atlanta, told Reuters Health. “This is pointing out that within communities there is variation in the local or neighborhood area.”
The findings of the study are based on 14,225 cases of cardiac arrest from 29 non-rural parts of the US. Using census data, the researchers separated these sites into two categories: high income, where household income was $40,000 and up; and low income. Each neighborhood was given an ethnic classification if that group made up more than 80 percent of the population.
Once baselines for the study were set, Sasson and her colleagues teased out the results. They found the overall chance of a victim receiving CPR from a bystander was about 29 percent. The percentage was highest (55%) in wealthy, predominantly-white neighborhoods. However, if that same person crossed the street and was in a poorer, mostly-black neighborhood, his or her chance of receiving CPR drops to 35 percent.
Sasson said information received from focus groups suggests the reason your survival odds are lower in poorer neighborhoods is because of the cost of learning CPR. Most classes cost $250, which is a large chunk out of someone´s monthly budget, especially if they are making less than $20,000 a year, she noted. “A lot of folks would love to learn it, but they can´t.”
The study further found that cardiac arrest victims “who received bystander CPR were more likely to be male and white. Black and Latino patients were less likely to receive CPR,” said McNally. “The association was most apparent in low-income black neighborhoods where the odds of receiving bystander CPR was 50 percent lower than that of a high-income non-black neighborhood.”
Sasson, McNally, and their colleagues say because of their findings, there needs to exist a commitment to increase CPR training efforts for all people. In the past, CPR training required multiple lessons, was intimidating and was offered in conventional settings. Nowadays, it is much faster, simpler and easier to learn and remember.
“Rather than widely blanketing the entire U.S. with CPR training, a targeted, tailored approach in these "high-risk" neighborhoods may be a more efficient method, given limited resources,” said McNally.
And the call for more training is just, because the proof is in the pudding. CPR given in the first few minutes after a cardiac arrest is crucial for survival. And in most cases, EMTs often do not arrive on scene for minutes, making it all the more important for trained CPR bystanders to step up to the plate and potentially save a human life.
Currently, survival rates vary greatly from city to city. In Seattle, the cardiac arrest survival rate is 16 percent. Yet in Detroit, the survival rate is only 0.2 percent.
It isn´t exactly clear why difference like these exist, noted Sasson. Although, Seattle´s widespread culture of CPR training most likely helps, along with the fact its citizens are predominantly white and more well-to-do than those in Detroit.
Sasson, being an ER physician, said she sees her share of cardiac arrest victims each year. “I would see African-Americans coming in and dying from cardiac arrests after having laid there for 10 minutes with no one delivering CPR.”
“There is no reason in 2012 that this kind of disparity exists - that you live or die depending on what side of the street you drop on. It is simply unacceptable,” she concluded.