The Relationship Between Socioeconomic Factors and the Rates of Bystander Cardiopulmonary Resuscitation

High-quality bystander cardiopulmonary resuscitation (CPR) is a key element in successful resuscitation from out-of-hospital cardiac arrests (OHCA). However, less than 40% of adults receive bystander-initiated CPR.

To investigate the relationship between socioeconomic variables and initiation of bystander CPR in OHCA.

A total of 504 adults were treated at one of three Emergency Departments between January 1, 2020, and December 31, 2022, for nontraumatic OHCA. Bystander CPR administration was the grouping variable, while socioeconomic variables included Area Deprivation Index (ADI), population density, income, primary language, and poverty level. Chi-squared and group t-tests were performed.

Overall, 4.9% of all OHCA survived to hospital discharge. Survival for bystander CPR patients was 8.4% compared to 2.7% with no bystander CPR (p < 0.004). OHCA without bystander CPR occurred in places with higher state and national decile ADI (mean 6.63 vs. 4.87, p < 0.001 and 70.25 vs. 55.39, p < 0.001, respectively), a higher percentage of families below the poverty level (mean 14.17 vs. 9.58, p < 0.001), and a lower median household income (mean $63,116 vs. $75,539, p < 0.001) than cases with bystander CPR. Cases without bystander CPR happened in locales with higher population density (mean 4428 vs. 3017 persons/square mile, p < 0.001), and a higher percentage of the population speaking a language other than English (mean 27.42% vs. 19.64%, p < 0.001).

Bystander CPR improves OHCA survivability. Lower socioeconomic status, higher population density, and higher percentage of non-English-speaking population have lower rates of bystander CPR use. Community engagement should target these areas to improve CPR training, bystander CPR initiation, and OHCA survivability.