Identifying high-risk geographic areas for cardiac arrest using three methods for cluster analysis

Area of Science:

• Public Health
• Spatial Epidemiology
• Emergency Medicine

Background:

• Out-of-hospital cardiac arrest (OHCA) survival is influenced by bystander cardiopulmonary resuscitation (CPR) rates.
• Identifying areas with high OHCA incidence and low bystander CPR is crucial for targeted interventions.

Purpose of the Study:

• To identify high-risk census tracts with both high OHCA incidence and low bystander CPR prevalence.
• Utilize three distinct spatial statistical methods for robust identification of at-risk areas.

Main Methods:

• Secondary analysis of prospectively collected OHCA registries in Columbus, Ohio (2004-2009).
• Inclusion criteria: adult cardiac etiology OHCA patients treated by emergency medical services.
• Spatial analysis methods: Global Empirical Bayes, Local Moran's I, and SaTScan's spatial scan statistic.

Main Results:

• A total of 1,632 OHCA cases were analyzed across 200 census tracts.
• Overall OHCA incidence was 0.70 per 1,000 person-years; bystander CPR was performed in 20.2% of cases.
• Five high-risk census tracts were consistently identified by all three spatial analysis methods.

Conclusions:

• The identified high-risk census tracts represent key areas for community-based interventions.
• Targeted efforts in CPR training and cardiovascular disease education can improve OHCA survival rates.