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Resuscitation. 2014 Nov;85(11):1512-7. doi: 10.1016/j.resuscitation.2014.08.013. Epub 2014 Aug 30.

Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and rates of bystander-initiated CPR: implications for community-based education intervention.

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Duke Clinical Research Institute, Durham, NC, USA. Electronic address:
Duke Clinical Research Institute, Durham, NC, USA.
School of Natural Resources and Environment, University of Michigan, Ann Arbor, MI, USA; Nicholas School of the Environment, Duke University, Durham, NC, USA.
Mecklenburg Emergency Medical Services Agency, Charlotte, NC, USA.
Wake County Department of Emergency Medical Services, Raleigh, NC, USA.
Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA, USA.
St. Michael's Hospital, University of Toronto, Toronto, Canada.
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA.
Division of Emergency Medicine, Department of Surgery, Duke University Health System, Durham, NC, USA.



A 10-fold regional variation in survival after out-of-hospital cardiac arrest (OHCA) has been reported in the United States, which partly relates to variability in bystander cardiopulmonary resuscitation (CPR) rates. In order for resources to be focused on areas of greatest need, we conducted a geospatial analysis of variation of CPR rates.


Using 2010-2011 data from Durham, Mecklenburg, and Wake counties in North Carolina participating in the Cardiac Arrest Registry to Enhance Survival (CARES) program, we included all patients with OHCA for whom resuscitation was attempted. Geocoded data and logistic regression modeling were used to assess incidence of OHCA and patterns of bystander CPR according to census tracts and factors associated herewith.


In total, 1466 patients were included (median age, 65 years [interquartile range 25]; 63.4% men). Bystander CPR by a layperson was initiated in 37.9% of these patients. High-incidence OHCA areas were characterized partly by higher population densities and higher percentages of black race as well as lower levels of education and income. Low rates of bystander CPR were associated with population composition (percent black: OR, 3.73; 95% CI, 2.00-6.97 per 1% increment in black patients; percent elderly: 3.25; 1.41-7.48 per 1% increment in elderly patients; percent living in poverty: 1.77, 1.16-2.71 per 1% increase in patients living in poverty).


In 3 counties in North Carolina, areas with low rates of bystander CPR can be identified using geospatial data, and education efforts can be targeted to improve recognition of cardiac arrest and to augment bystander CPR rates.


Bystander cardiac pulmonary resuscitation; OHCA; Out-of-hospital cardiac arrest

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